Healthcare Provider Details

I. General information

NPI: 1851599534
Provider Name (Legal Business Name): ELIZA LADYZHENSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

126 SOUTH ORANGE DRIVE
LOS ANGELES CA
90036-3039
US

IV. Provider business mailing address

126 SOUTH ORANGE DRIVE
LOS ANGELES CA
90036-3039
US

V. Phone/Fax

Practice location:
  • Phone: 951-206-9628
  • Fax: 323-549-9629
Mailing address:
  • Phone: 951-206-9628
  • Fax: 323-549-9629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License NumberA38784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: