Provider Demographics
NPI:1689846610
Name:CHIRADZE, EKATERINE K (P A )
Entity Type:Individual
Prefix:
First Name:EKATERINE
Middle Name:K
Last Name:CHIRADZE
Suffix:
Gender:F
Credentials:P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 ONE AND HALF S RAMPART BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057
Mailing Address - Country:US
Mailing Address - Phone:213-368-1113
Mailing Address - Fax:213-368-1313
Practice Address - Street 1:274 ONE AND HALF S RAMPART BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1984
Practice Address - Country:US
Practice Address - Phone:213-368-1113
Practice Address - Fax:213-368-1313
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19548363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA19548OtherLICENSE