Individual provider Active NPI

Ezequiel Adony Andrade, MD

  • Geriatric Medicine (Family Medicine) Physician
  • Harbor City, CA
National Provider Identifier
1689296576
Registry record updated Feb 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
A181210 Issued in CA
Practice address
1403 Lomita Blvd Ste 102
Harbor City, CA 90710-2084
Phone
(424) 306-4000
NPI assigned
May 13, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X A181210 CA
Geriatric Medicine (Family Medicine) Physician 207QG0300X A181210 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1403 Lomita Blvd Ste 102
Harbor City, CA 90710-2084

Mailing address

1403 Lomita Blvd Ste 200
Harbor City, CA 90710-2086
Phone (424) 306-6500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241115003863 CA Practitioner - Family Practice 8224562921 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Un of California, Irvine, College of Medicine, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1670 E 120TH St
Los Angeles, CA 90059-3026

Hospital & facility affiliations

  • Lac/Harbor-UCLA Med Center Hospital, Torrance, CA, CCN 050376

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles CurrentSince Aug 17, 2024 Accepting new patients
County of Los Angeles CurrentSince Aug 17, 2024 Accepting new patients

Locations

1000 S Fremont Ave
Bldg A11
Alhambra, CA 91803
Phone (626) 457-4240

1670 E 120th St
Los Angeles, CA 90059
Phone (424) 338-1000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708214400000",
    "number": "1689296576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1403 LOMITA BLVD STE 200",
            "city": "HARBOR CITY",
            "state": "CA",
            "postal_code": "907102086",
            "telephone_number": "424-306-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1403 LOMITA BLVD STE 102",
            "city": "HARBOR CITY",
            "state": "CA",
            "postal_code": "907102084",
            "telephone_number": "424-306-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDRADE",
        "first_name": "EZEQUIEL",
        "middle_name": "ADONY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-05-13",
        "last_updated": "2024-02-18",
        "certification_date": "2024-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "CA",
            "license": "A181210",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A181210",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harbor City, CA

Sources for this page

Verify at the official NPI Registry.