Basic Information
| Provider Information | |||||||||
| NPI: | 1376754721 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEUTSCHE | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ANDERSON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2231 KELTON AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900642010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104776670 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6041 CADILLAC AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900341702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238572000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080H0002X | G17402 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Hospice and Palliative Medicine |
No ID Information.