Individual
GEORGIA KONSTANDOPOU BODE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4060 WHITTIER BLVD, LOS ANGELES, CA 90023-2526
(323) 268-5514
Mailing address
P.O. BOX 3999, TORRANCE, CA 90510-3999
(310) 792-3914
(310) 792-3802
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A40295
CA
208VP0000X
Pain Medicine Physician
A40295
CA
208VP0014X
Interventional Pain Medicine Physician
A40295
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A402950
BLUE SHIELD
CA
05
—
00A402951
—
CA
Enumeration date
04/26/2006
Last updated
04/11/2014
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