Healthcare Provider Details

I. General information

NPI: 1043363872
Provider Name (Legal Business Name): CECELIA THERESA MADRID M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W ALAMEDA AVE STE 500
BURBANK CA
91505-4410
US

IV. Provider business mailing address

2701 W ALAMEDA AVE STE 500
BURBANK CA
91505-4410
US

V. Phone/Fax

Practice location:
  • Phone: 818-567-6550
  • Fax: 818-558-4379
Mailing address:
  • Phone: 818-567-6550
  • Fax: 818-558-4379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG48480
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG48480
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberG48480
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG48480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: