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General NPI Number Information
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NPI Number | 1174436117
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Entity Type | Organization
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Legal Business Name | LDA MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 2632 WILSHIRE BLVD STE 685
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City | SANTA MONICA
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State | CA
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Zip | 90403
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Country | US
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Telephone | 310-424-7013
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Fax | 239-999-1340
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Provider Business Mailing Address
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Address Line | 2632 WILSHIRE BLVD STE 685
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City | SANTA MONICA
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State | CA
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Zip | 90403
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Country | US
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Telephone | 310-424-7013
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Fax | 239-999-1340
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ALI J ENAYATI
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Credential | MD, MPH
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Telephone | 310-424-7013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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