Healthcare Provider Details

I. General information

NPI: 1801984554
Provider Name (Legal Business Name): BEATRICE CARDENAS KALATA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14829 HAWTHORNE BLVD #201
LAWNDALE CA
90260
US

IV. Provider business mailing address

14829 HAWTHORNE BLVD #201
LAWNDALE CA
90260
US

V. Phone/Fax

Practice location:
  • Phone: 310-973-6727
  • Fax: 310-973-0661
Mailing address:
  • Phone: 310-973-6727
  • Fax: 310-973-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA43106
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA43106
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: