Organization · NPI-2

Axoderm Corp

Emergency Medicine, Medical Toxicology · Glendale, CA

NPI number1891675674
StatusActive
Last updated in NPPESSep 3, 2025

Details

NPI
1891675674
Entity type
Organization (NPI-2)
Legal business name
Axoderm Corp
Organization subpart
No
Enumeration date
Sep 3, 2025
Certification date
Sep 3, 2025
Last updated
Sep 3, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207PT0002X Emergency Medicine, Medical Toxicology––Yes

Practice location

1510 S Central Ave Ste 640
Glendale, CA 91204-2552

Phone 310-933-5054 · Fax 310-935-3367

Mailing address

1510 S Central Ave Ste 640
Glendale, CA 91204-2552

Phone 310-933-5054 · Fax 310-935-3367

Authorized official

Angie Davoody
Office Manager / Executive
8182423200

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