=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558602185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HELDER DE PAIVA MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2013
-----------------------------------------------------
Last Update Date | 02/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5901 W OLYMPIC BLVD STE 307
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-205-2595
-----------------------------------------------------
Fax | 310-388-5999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5901 W OLYMPIC BLVD STE 307
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90036-4664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-205-2595
-----------------------------------------------------
Fax | 310-388-5999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. HELDER DE PAIVA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 310-845-5989
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | ME92869
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------