Provider Demographics
NPI:1871529248
Name:NADIM, MITRA (MD)
Entity type:Individual
Prefix:DR
First Name:MITRA
Middle Name:
Last Name:NADIM
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 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-1309
Mailing Address - Country:US
Mailing Address - Phone:323-442-5100
Mailing Address - Fax:323-442-5641
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-5100
Practice Address - Fax:323-442-5641
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63716207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0016910OtherGROUP MEDICAID PIN
CA00A637160197OtherCAL OPTIMA
CA00A637160Medicaid
CA390008500OtherRAILROAD MEDICARE
CA00A637160OtherBLUE SHIELD
CA1902846306OtherGROUP NPI
CACE1617OtherGROUP RAILROAD MEDICARE
CAW18762OtherMEDICARE GROUP ID
CA1902846306OtherGROUP NPI
CAH69250Medicare UPIN