Provider Demographics
NPI:1548851280
Name:NAVNEET K. BODDU, M. D. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:NAVNEET K. BODDU, M. D. A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAVNEET
Authorized Official - Middle Name:K
Authorized Official - Last Name:BODDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-429-7172
Mailing Address - Street 1:638 CAMINO DE LOS MARES STE H130-517
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2848
Mailing Address - Country:US
Mailing Address - Phone:760-429-7172
Mailing Address - Fax:760-429-7161
Practice Address - Street 1:2125 S EL CAMINO REAL STE 200
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6260
Practice Address - Country:US
Practice Address - Phone:760-429-7172
Practice Address - Fax:760-429-7161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty