MEDICARE: DR. MADHAV R BODDULA M.D., M.P.H.

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	207X00000X	Orthopaedic Surgery Physician	A96091	CA

General Provider Information

NPI Number	:	1740355643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MADHAV R BODDULA M.D., M.P.H.

Provider Business Mailing Address
First Line	:	580 W MAIN ST APT 128
Second Line	:
City	:	ALHAMBRA
State	:	CA
Zip	:	91801-3368
Country	:	US
Telephone Number	:	714-686-8655
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 N. STATE ST, GNH 3900
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033
Country	:	US
Telephone Number	:	323-226-7210
Fax Number	:

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

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	12/01/2021

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