Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | G48480 | CA |
Y | 111NI0900X | Internist | G48480 | CA |
N | 207RG0100X | Gastroenterologist | G48480 | CA |
N | 207RG0300X | Geriatric Medicine | G48480 | CA |
NPI | 1043363872 |
---|---|
Provider Name | Dr. Cecelia Theresa Madrid |
First Address | Burbank, CA 91505-4410 |
Second Address | Burbank, CA 91505-4410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 20/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G484800 | (05) | CA |
00G484800 | BLUE SHIELD (01) | CA |
95 4245140 | TAX IDENTIFICATION NUMBER (01) | |
954245140 | BLUE CROSS (01) | CA |
A51073 | (02) | CA |