=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417907452
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA TERESA SWIDA D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 03/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2750 W BROADWAY
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90041-1050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-550-8346
-----------------------------------------------------
Fax | 323-550-8366
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2425
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91102-2425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-550-8346
-----------------------------------------------------
Fax | 323-550-8366
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 20A6314
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------