Provider Demographics
NPI:1679524292
Name:WARNECKE, IRMA (MD)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:WARNECKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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:323-255-5643
Mailing Address - Fax:323-254-2158
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:2021-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA55445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A554450OtherBLUE SHIELD
CA00A554450Medicaid
GA080120011OtherMEDICARE RAILROAD
GA080120011OtherMEDICARE RAILROAD
CAG26363Medicare UPIN
CAWA55445BMedicare PIN