Healthcare Provider Details

I. General information

NPI: 1942303219
Provider Name (Legal Business Name): ANITA T CHUA-LADDARAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANITA CHUA LADDARAN M.D.

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 BEVERLY BLVD STE 117
LOS ANGELES CA
90057
US

IV. Provider business mailing address

2105 BEVERLY BLVD STE 117
LOS ANGELES CA
90057
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-8742
  • Fax: 213-413-6482
Mailing address:
  • Phone: 213-413-8742
  • Fax: 213-413-6482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA365070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: