Provider Demographics
NPI:1083647697
Name:CALIFORNIA TRAUMA MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:CALIFORNIA TRAUMA MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:GUDATA
Authorized Official - Middle Name:
Authorized Official - Last Name:HINIKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-742-6407
Mailing Address - Street 1:320 W 15TH ST STE 313
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3007
Mailing Address - Country:US
Mailing Address - Phone:213-742-6407
Mailing Address - Fax:213-748-9353
Practice Address - Street 1:1401 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3010
Practice Address - Country:US
Practice Address - Phone:213-742-6407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63029174400000X
CAG60225174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19396Medicare PIN