Basic Information
| Provider Information | |||||||||
| NPI: | 1831717768 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALEXANDER GHATAN, DO, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1255 FEDERAL AVE APT 104 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900253969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186130551 | ||||||||
| FaxNumber: | 8187893967 | ||||||||
| Practice Location | |||||||||
| Address1: | 16952 VENTURA BLVD | ||||||||
| Address2: | |||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913164197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187893964 | ||||||||
| FaxNumber: | 8187893967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2020 | ||||||||
| LastUpdateDate: | 07/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | GHATAN | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8186130551 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 07/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.