Provider Demographics
NPI:1144244211
Name:PRECIADO, MARTHA ROSE (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ROSE
Last Name:PRECIADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:ROSE
Other - Last Name:FROIDEVAUX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1701 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:SUITE 355
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2464
Mailing Address - Country:US
Mailing Address - Phone:323-225-8025
Mailing Address - Fax:323-225-8815
Practice Address - Street 1:1701 E CESAR E CHAVEZ AVE
Practice Address - Street 2:SUITE 355
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2464
Practice Address - Country:US
Practice Address - Phone:323-225-8025
Practice Address - Fax:323-225-8815
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51820207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93113Medicare UPIN
CAG51820Medicare ID - Type UnspecifiedMEDICARE NUMBER