MEDICARE: DR. NEELAM PATHIKONDA D.O. MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	20A13100	CA

General Provider Information

NPI Number	:	1346505294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEELAM PATHIKONDA D.O. MPH

Provider Business Mailing Address
First Line	:	1550 W MANCHESTER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-5424
Country	:	US
Telephone Number	:	800-954-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 W MANCHESTER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-5424
Country	:	US
Telephone Number	:	800-954-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	11/29/2021

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