Provider Demographics
NPI:1467449389
Name:ODONNELL, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ODONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2328
Mailing Address - Country:US
Mailing Address - Phone:213-637-3703
Mailing Address - Fax:213-639-0797
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:SUITE 8211
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:213-637-3703
Practice Address - Fax:213-639-0797
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59376207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE67378Medicare UPIN
CAWG593776Medicare ID - Type Unspecified