# KERLAN-JOBE ORTHOPAEDIC CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639141153
- **Authorized official:** DR. RALPH A GAMBARDELLA M.D. (PRESIDENT)
- **Authorized official phone:** (310) 665-7235

## Contact information

- **Practice address:** 6801 PARK TER, SUITE 500, LOS ANGELES, CA 90045-1543
- **Practice address phone:** (310) 665-7235
- **Mailing address:** 6801 PARK TER, SUITE 500, LOS ANGELES, CA 90045-1543
- **Mailing address phone:** (310) 665-7235

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 02/07/2006
- **Last updated:** 03/05/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | ZZZ56985Z | BLUE SHIELD OF CA | CA |
| 01 | — | ZZZ56988Z | BLUE SHIELD OF CA | CA |
| 05 | — | ZZZ788127 | — | CA |
| 01 | — | ZZZ98667Z | BLUE SHIELD OF CA | CA |