Provider Demographics
NPI:1205903317
Name:LLADO, CARMENCITA (MD)
Entity type:Individual
Prefix:DR
First Name:CARMENCITA
Middle Name:
Last Name:LLADO
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:PO BOX 10432
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-3432
Mailing Address - Country:US
Mailing Address - Phone:213-637-2530
Mailing Address - Fax:213-384-3373
Practice Address - Street 1:2208 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4002
Practice Address - Country:US
Practice Address - Phone:213-384-3434
Practice Address - Fax:213-386-2039
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52371208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A523710Medicaid
WA52371FMedicare ID - Type UnspecifiedPPIN NUMBER (GRP W14032)
WA52371JMedicare ID - Type UnspecifiedPPIN NUMBER (GRP W14027)
WA52371GMedicare ID - Type UnspecifiedPPIN NUMBER (GRP W14021)
WA52371HMedicare ID - Type UnspecifiedPPIN NUMBER (GRP W14067)
WA52371KMedicare ID - Type UnspecifiedPPIN NUMBER (GRP W14020)
WA52371IMedicare ID - Type UnspecifiedPPIN NUMBER (GRP W14028)
CA00A523710Medicaid