Provider Demographics
NPI:1043363872
Name:MADRID, CECELIA THERESA (MD)
Entity type:Individual
Prefix:DR
First Name:CECELIA
Middle Name:THERESA
Last Name:MADRID
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 1:2701 W ALAMEDA AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4410
Mailing Address - Country:US
Mailing Address - Phone:818-567-6550
Mailing Address - Fax:818-558-4379
Practice Address - Street 1:2701 W ALAMEDA AVE STE 500
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4410
Practice Address - Country:US
Practice Address - Phone:818-567-6550
Practice Address - Fax:818-558-4379
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48480207RG0100X, 207RG0300X, 2084P0800X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G484800OtherBLUE SHIELD
CA00G484800Medicaid
95 4245140OtherTAX IDENTIFICATION NUMBER
CA954245140OtherBLUE CROSS
CA954245140OtherBLUE CROSS
CAA51073Medicare UPIN