Basic Information
| Provider Information | |||||||||
| NPI: | 1396824785 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADARANG | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2725 SW CEDAR HILLS BLVD | ||||||||
| Address2: | STE 250 | ||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970051469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165363620 | ||||||||
| FaxNumber: | 9165363541 | ||||||||
| Practice Location | |||||||||
| Address1: | 6555 COYLE AVE | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956080302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165363620 | ||||||||
| FaxNumber: | 9165363541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2006 | ||||||||
| LastUpdateDate: | 01/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD184006 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | A84980 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A849800 | 01 | CA | BLUE SHIELD | OTHER | 90138934 | 01 | CA | PACIFICARE | OTHER | 000810587265 | 01 | CA | PHCS | OTHER | 7610562 | 01 | CA | FIRST HEALTH | OTHER | 00A849800 | 05 | CA | MEDICAID | MCMG297000 | 01 | CA | WESTERN HEALTH ADVANTAGE | OTHER | 2397651 | 01 | CA | UNITED HEALTHCARE | OTHER | 101971 | 01 | CA | INTERPLAN | OTHER | 104585 | 01 | CA | HEALTH NET | OTHER | 2165740 | 01 | CA | GREAT WEST | OTHER | 7721542 | 01 | CA | AETNA | OTHER | A84980 | 01 | CA | BLUE CROSS | OTHER |