Provider Demographics
NPI:1821411281
Name:DENISE A. ALBURY M.D., INC.
Entity Type:Organization
Organization Name:DENISE A. ALBURY M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALBURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-497-0028
Mailing Address - Street 1:5550 S VERDUN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1525
Mailing Address - Country:US
Mailing Address - Phone:323-497-0028
Mailing Address - Fax:
Practice Address - Street 1:133 N PRAIRIE AVE
Practice Address - Street 2:B
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4879
Practice Address - Country:US
Practice Address - Phone:310-419-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74533208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G745330Medicaid