Provider Demographics
NPI:1457391468
Name:SILVA, MAURICIO (MD)
Entity Type:Individual
Prefix:
First Name:MAURICIO
Middle Name:
Last Name:SILVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAURICIO
Other - Middle Name:
Other - Last Name:CARRENO-SILVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:403 W ADAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-2664
Mailing Address - Country:US
Mailing Address - Phone:213-742-1000
Mailing Address - Fax:213-742-1435
Practice Address - Street 1:403 W ADAMS BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007
Practice Address - Country:US
Practice Address - Phone:213-742-1000
Practice Address - Fax:213-742-1435
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101859207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457391468Medicaid
CA1457391468Medicaid