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General NPI Number Information
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NPI Number | 1871404046
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Entity Type | Organization
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Legal Business Name | MEDPODLA MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/15/2026
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Last Update Date | 09/15/2026
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Provider Practice Location Address
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Address Line | 465 N ROXBURY DR STE 911
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4212
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Country | US
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Telephone | 424-279-6337
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Fax |
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Provider Business Mailing Address
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Address Line | 10490 WYTON DR
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City | LOS ANGELES
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State | CA
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Zip | 90024-2554
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Country | US
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Telephone | 424-279-6337
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Fax |
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Authorized Official
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Title or Position | LEAD PHYSICIAN
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Name | DANIEL GHIYAM
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Credential | MD
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Telephone | 424-279-6337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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