MEDICARE: DR. KATHLEEN TREUDLEY TEDESCO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080N0001X	Neonatal-Perinatal Medicine Physician	A186303	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1972130193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHLEEN TREUDLEY TEDESCO MD

Provider Business Mailing Address
First Line	:	1200 N STATE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1083
Country	:	US
Telephone Number	:	323-409-5707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 N STATE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1029
Country	:	US
Telephone Number	:	323-409-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2020
Last Update Date	:	06/02/2026

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