Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A115129 | CA |
N | 111NI0900X | Internist | A115129 | CA |
Y | 207RH0002X | Hospice and Palliative Medicine | A115129 | CA |
NPI | 1235435074 |
---|---|
Provider Name | Alexander James Madonis |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2011 |
Last Update Date | 11/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1902846306 | GROUP NPI (01) | CA |
GR0100430 | GROUP MEDI-CAL (01) | CA |
W18762 | GROUP MEDICARE (01) | CA |