Provider Demographics
NPI:1477572477
Name:MADANI, GHODSI (MD)
Entity Type:Individual
Prefix:DR
First Name:GHODSI
Middle Name:
Last Name:MADANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 TORRANCE BLVD STE 365
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4513
Mailing Address - Country:US
Mailing Address - Phone:310-792-1786
Mailing Address - Fax:310-792-8007
Practice Address - Street 1:4201 TORRANCE BLVD STE 365
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4513
Practice Address - Country:US
Practice Address - Phone:310-792-1786
Practice Address - Fax:310-792-8007
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32110174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50184Medicare UPIN