Provider Demographics
NPI:1922320951
Name:BODIWALA, AMISHA VISHAL (RT,(R)(M))
Entity Type:Individual
Prefix:
First Name:AMISHA
Middle Name:VISHAL
Last Name:BODIWALA
Suffix:
Gender:F
Credentials:RT,(R)(M)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11075 CAMINO PLAYA CARMEL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-4142
Mailing Address - Country:US
Mailing Address - Phone:908-307-7218
Mailing Address - Fax:
Practice Address - Street 1:11075 CAMINO PLAYA CARMEL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-4142
Practice Address - Country:US
Practice Address - Phone:908-307-7218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ631701247100000X
NJARRT 331992247100000X
CARHM943002471C3402X, 2471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography