Basic Information
| Provider Information | |||||||||
| NPI: | 1578810412 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GERARD MADZAR | ||||||||
| FirstName: | ISABELLE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GERARD | ||||||||
| OtherFirstName: | ISABELLE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 801 S CHEVY CHASE DR | ||||||||
| Address2: | STE 230 | ||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912054431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185005586 | ||||||||
| FaxNumber: | 8185005587 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 S CHEVY CHASE DR | ||||||||
| Address2: | STE 230 | ||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912054431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185005586 | ||||||||
| FaxNumber: | 8185005587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2012 | ||||||||
| LastUpdateDate: | 08/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A122056 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.