Provider Demographics
NPI:1457676793
Name:ELIZABETH REMEDIOS MD INC
Entity Type:Organization
Organization Name:ELIZABETH REMEDIOS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:REMEDIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-507-8022
Mailing Address - Street 1:PO BOX 27206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-0206
Mailing Address - Country:US
Mailing Address - Phone:213-385-0675
Mailing Address - Fax:213-365-6429
Practice Address - Street 1:423 W COLORADO ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1537
Practice Address - Country:US
Practice Address - Phone:818-507-8022
Practice Address - Fax:818-507-8185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55283208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADF652AMedicare PIN
CAA93360Medicare UPIN