Individual
IRA PAULA WARDONO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
18321 CLARK ST, TARZANA, CA 91356-3501
(818) 881-0800
Mailing address
6430 W SUNSET BLVD, SUITE 600, LOS ANGELES, CA 90028-7900
(323) 361-2337
(323) 361-8491
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A112875
CA
208000000X
Pediatrics Physician
MD431846
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001993563
BLUE SHIELD
PA
05
—
1020378080001
—
PA
01
—
824184
FPH
PA
Enumeration date
06/19/2007
Last updated
07/01/2020
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