Provider Demographics
NPI:1598869018
Name:TADROS, GEORGETTE (MD)
Entity Type:Individual
Prefix:MRS
First Name:GEORGETTE
Middle Name:
Last Name:TADROS
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 1:931 BUENA VISTA
Mailing Address - Street 2:STE 202
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010
Mailing Address - Country:US
Mailing Address - Phone:626-301-1515
Mailing Address - Fax:626-301-1519
Practice Address - Street 1:931 BUENA VISTA
Practice Address - Street 2:STE 202
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010
Practice Address - Country:US
Practice Address - Phone:626-301-1515
Practice Address - Fax:626-301-1519
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA954241388208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A42125Medicaid
954241388Medicare UPIN