Provider Demographics
NPI:1265756860
Name:KRAISH, EWA IZABELA (MD)
Entity type:Individual
Prefix:
First Name:EWA
Middle Name:IZABELA
Last Name:KRAISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EWA
Other - Middle Name:IZABELA
Other - Last Name:BADDAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1252 VIN SCULLY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4407
Mailing Address - Country:US
Mailing Address - Phone:909-561-6315
Mailing Address - Fax:
Practice Address - Street 1:800 FAIRMOUNT AVE STE 220
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3154
Practice Address - Country:US
Practice Address - Phone:626-486-0181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA130454207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty