1801112057 NPI number — CELINA M. NADELMAN, MD, A MEDICAL CORPORATION

Table of content: (NPI 1801112057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801112057 NPI number — CELINA M. NADELMAN, MD, A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CELINA M. NADELMAN, MD, A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801112057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9663 SANTA MONICA BLVD
Provider Second Line Business Mailing Address:
STE 439
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90210-4303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-702-6701
Provider Business Mailing Address Fax Number:
310-935-3039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1125 S BEVERLY DR
Provider Second Line Business Practice Location Address:
STE 602
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90035-1148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-702-6701
Provider Business Practice Location Address Fax Number:
310-276-7624
Provider Enumeration Date:
04/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
NADELMAN
Authorized Official First Name:
CELINA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
LABORATORY DIRECTOR
Authorized Official Telephone Number:
310-702-6701

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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