Individual
NEIL S. GHODADRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
120 S SPALDING DR, SUITE 401, BEVERLY HILLS, CA 90212-1800
(310) 860-3048
(310) 550-7680
Mailing address
10780 SANTA MONICA BLVD, SUITE 210, LOS ANGELES, CA 90025-4749
(310) 453-5404
(310) 453-2535
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
125-050000
IL
207X00000X
Orthopaedic Surgery Physician
Primary
A116163
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FH410Z
MEDICARE PTAN
CA
Enumeration date
08/25/2008
Last updated
04/07/2017
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