Provider Demographics
NPI:1194926899
Name:CADRY, MEHRANGIZ (MD)
Entity type:Individual
Prefix:
First Name:MEHRANGIZ
Middle Name:
Last Name:CADRY
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 1:2707 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-5527
Mailing Address - Country:US
Mailing Address - Phone:310-422-5001
Mailing Address - Fax:
Practice Address - Street 1:2707 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-5527
Practice Address - Country:US
Practice Address - Phone:310-422-5001
Practice Address - Fax:978-477-8189
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39988207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1194926899Medicaid
CA1194926899Medicare Oscar/Certification
CA1194926899Medicaid
CA1194926899Medicare UPIN
CA1194926899Medicare PIN