Provider Demographics
NPI:1952321101
Name:TAYLOR, MIHAELA BOTEA (MD)
Entity Type:Individual
Prefix:
First Name:MIHAELA
Middle Name:BOTEA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5632
Mailing Address - Country:US
Mailing Address - Phone:310-828-7172
Mailing Address - Fax:310-394-7807
Practice Address - Street 1:200 MEDICAL PLAZA
Practice Address - Street 2:#365,530,420,120
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-828-7172
Practice Address - Fax:310-394-7807
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA76429207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A764290Medicaid
CAWA76429AMedicare PIN
CAI05288Medicare UPIN
CAWA76429BMedicare PIN