Healthcare Provider Details

I. General information

NPI: 1376754721
Provider Name (Legal Business Name): MARY ANDERSON DEUTSCHE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6041 CADILLAC AVE
LOS ANGELES CA
90034-1702
US

IV. Provider business mailing address

2231 KELTON AVE
LOS ANGELES CA
90064-2010
US

V. Phone/Fax

Practice location:
  • Phone: 323-857-2000
  • Fax:
Mailing address:
  • Phone: 310-477-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License NumberG17402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: