Provider Demographics
NPI:1790979698
Name:KALDAS, MARIAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:
Last Name:KALDAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-8707
Mailing Address - Fax:
Practice Address - Street 1:3500 LOMITA BLVD STE 302
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5038
Practice Address - Country:US
Practice Address - Phone:310-257-0028
Practice Address - Fax:310-267-3840
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA107630207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790979698OtherCCS PANELED PROVIDER
CA1790979698Medicaid
CAGF312ZMedicare PIN