Provider Demographics
NPI:1164698098
Name:MA, JANET M (MD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:M
Last Name:MA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1245 16TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1240
Mailing Address - Country:US
Mailing Address - Phone:310-315-8900
Mailing Address - Fax:310-315-8902
Practice Address - Street 1:1245 16TH ST
Practice Address - Street 2:SUITE 125
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1235
Practice Address - Country:US
Practice Address - Phone:310-315-8900
Practice Address - Fax:310-315-8902
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108822208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1164698098Medicaid
CAGK819ZMedicare PIN