Provider Demographics
NPI:1851599534
Name:LADYZHENSKY, ELIZA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZA
Middle Name:
Last Name:LADYZHENSKY
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 1:126 SOUTH ORANGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3039
Mailing Address - Country:US
Mailing Address - Phone:951-206-9628
Mailing Address - Fax:323-549-9629
Practice Address - Street 1:126 SOUTH ORANGE DRIVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3039
Practice Address - Country:US
Practice Address - Phone:951-206-9628
Practice Address - Fax:323-549-9629
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38784202C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4785017Medicare UPIN