Basic Information
| Provider Information | |||||||||
| NPI: | 1851700199 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AVRAHAM | ||||||||
| FirstName: | SHIRLEY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 781548 GOLDEN STATE ANESTHESIA | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191781548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008632002 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1401 S GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2137482411 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2014 | ||||||||
| LastUpdateDate: | 11/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A162526 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 287647 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.