Provider Demographics
NPI:1053359232
Name:OSTRZEGA, ENRIQUE LEONARDO (MD)
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:LEONARDO
Last Name:OSTRZEGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31218
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0218
Mailing Address - Country:US
Mailing Address - Phone:626-457-5839
Mailing Address - Fax:
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:626-457-5839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50472207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356390009OtherGROUP NPI
CACE1617OtherGROUP RAILROAD MEDICARE
CA00A504720OtherBLUE SHIELD
CAGR0016910OtherGROUP MEDICAID PIN
CA60024346OtherRAILROAD MEDICARE
CAW11675OtherGROUP MEDICARE PIN
CA00A504720Medicaid
CAW11675OtherGROUP MEDICARE PIN
CAWA54072CMedicare PIN