Provider Demographics
NPI:1427000850
Name:MAVRINAC, MAUREEN (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MAVRINAC
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 1:5823 YORK BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-2634
Mailing Address - Country:US
Mailing Address - Phone:323-255-3437
Mailing Address - Fax:
Practice Address - Street 1:1701 E CESAR CHAVEZ AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2464
Practice Address - Country:US
Practice Address - Phone:323-226-1100
Practice Address - Fax:323-226-1101
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A444150Medicaid
CA00A444150OtherBLUE SHIELD
GAP00378055OtherMEDICARE RAILROAD
CAE18841Medicare UPIN
CA00A444150Medicaid