Provider Demographics
NPI:1962674960
Name:MATHURIA, NILESH (MD)
Entity type:Individual
Prefix:
First Name:NILESH
Middle Name:
Last Name:MATHURIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-206-2235
Mailing Address - Fax:310-825-2092
Practice Address - Street 1:200 MEDICAL PLZ
Practice Address - Street 2:SUITE 365C
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-206-2235
Practice Address - Fax:310-825-2092
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2010-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL9801207R00000X
CAC53713207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADR333ZMedicare PIN
TX8K8416Medicare PIN