Provider Demographics
NPI:1154490324
Name:NEEDELMAN, JOEL ALAN
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ALAN
Last Name:NEEDELMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11980 SAN VINCENTE BLVD
Mailing Address - Street 2:104
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049
Mailing Address - Country:US
Mailing Address - Phone:310-820-1496
Mailing Address - Fax:310-820-4186
Practice Address - Street 1:11980 SAN VINCENTE BLVD
Practice Address - Street 2:104
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049
Practice Address - Country:US
Practice Address - Phone:310-820-1696
Practice Address - Fax:310-820-4186
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA194500Medicaid