Basic Information
| Provider Information | |||||||||
| NPI: | 1952465635 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUDRIC TIGANU | ||||||||
| FirstName: | BRINDUSA | ||||||||
| MiddleName: | DANA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 W. HUNTINGTON DRIVE | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265143442 | ||||||||
| FaxNumber: | 6265743592 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 W. HUNTINGTON DRIVE | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032767000 | ||||||||
| FaxNumber: | 2032767366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 12/05/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 044413 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 222260 | NY | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 044413 | CT | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | C52392 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 2239774 | 05 | NY | MEDICAID |