Provider Demographics
NPI:1801984554
Name:KALATA, BEATRICE CARDENAS (MD)
Entity type:Individual
Prefix:
First Name:BEATRICE
Middle Name:CARDENAS
Last Name:KALATA
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 1:14829 HAWTHORNE BLVD
Mailing Address - Street 2:#201
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260
Mailing Address - Country:US
Mailing Address - Phone:310-973-6727
Mailing Address - Fax:310-973-0661
Practice Address - Street 1:14829 HAWTHORNE BLVD
Practice Address - Street 2:#201
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260
Practice Address - Country:US
Practice Address - Phone:310-973-6727
Practice Address - Fax:310-973-0661
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2010-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43106208D00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43106Medicaid
A85855Medicare UPIN
CAA43106Medicaid