Provider Demographics
NPI:1023024916
Name:MODI, MEERA (MD)
Entity Type:Individual
Prefix:
First Name:MEERA
Middle Name:
Last Name:MODI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-1217
Mailing Address - Country:US
Mailing Address - Phone:213-250-3716
Mailing Address - Fax:213-250-5682
Practice Address - Street 1:1100 W. SUNSET BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1217
Practice Address - Country:US
Practice Address - Phone:213-250-3716
Practice Address - Fax:213-250-5682
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93372207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A399721Medicaid
CA110020280OtherMEDICARE RAILROAD
CAE09257Medicare UPIN
CA00A399721Medicaid
CAA39972Medicare PIN