Provider Demographics
NPI:1912964255
Name:OFTADEH, LYDIA CAVALES (MD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:CAVALES
Last Name:OFTADEH
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 3925
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-3925
Mailing Address - Country:US
Mailing Address - Phone:323-582-5458
Mailing Address - Fax:323-835-1475
Practice Address - Street 1:4566 FLORENCE AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-4345
Practice Address - Country:US
Practice Address - Phone:323-582-5458
Practice Address - Fax:323-835-1475
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50327174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA50327WMedicare ID - Type Unspecified
CAG16311Medicare UPIN
CAWA50327VMedicare ID - Type Unspecified