Individual provider Active NPI

Maria del Carmen Frias Kletecka, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Los Angeles, CA
National Provider Identifier
1801004403
Registry record updated Apr 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
C154326 Issued in CA
Practice address
11301 Wilshire Blvd RM 1255
Los Angeles, CA 90073-1003
Phone
(310) 478-3711
NPI assigned
May 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Molecular Genetic Pathology (Pathology) Physician 207ZP0007X C154326 CA
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X C154326 CA Primary

Addresses

Primary practice location

11301 Wilshire Blvd RM 1255
Los Angeles, CA 90073-1003

Mailing address

4991 Brewster Dr
Tarzana, CA 91356-4020

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
I20220503002637 CA Order and Referring Only - PathologyPractitioner - Pathology 0042476459

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C154326CAMDAnatomic Pathology & Clinical Pathology Physician

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651017600000",
    "number": "1801004403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4991 BREWSTER DR",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913564020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11301 WILSHIRE BLVD RM 1255",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900731003",
            "telephone_number": "310-478-3711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRIAS KLETECKA",
        "first_name": "MARIA DEL CARMEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-18",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0007X",
            "taxonomy_group": "",
            "desc": "Pathology, Molecular Genetic Pathology",
            "state": "CA",
            "license": "C154326",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "C154326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.