Provider Demographics
NPI:1417907452
Name:SWIDA, MARIA TERESA (DO)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:SWIDA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2425
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91102-2425
Mailing Address - Country:US
Mailing Address - Phone:323-550-8346
Mailing Address - Fax:323-550-8366
Practice Address - Street 1:2750 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1050
Practice Address - Country:US
Practice Address - Phone:323-550-8346
Practice Address - Fax:323-550-8366
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0059750Medicaid
CA20A6314BMedicare PIN
CABD300AMedicare PIN