Mira Cantrell, MD

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

A39040 Issued in CA

Practice address

11500 Nimitz Ave
Los Angeles, CA 90049-3566

Phone

(424) 832-8268

Fax

(424) 832-8270

NPI assigned

Jun 2, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319500800000",
    "number": "1932147055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11500 NIMITZ AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900493566",
            "telephone_number": "424-832-8268",
            "fax_number": "424-832-8270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11500 NIMITZ AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900493566",
            "telephone_number": "424-832-8268",
            "fax_number": "424-832-8270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANTRELL",
        "first_name": "MIRA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-02",
        "last_updated": "2011-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A39040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENCE",
            "identifier": "A39040",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Enrique Cantong, DC
• Alicia Cantor II
• Jenny Cantoran, LCSW
• Rachel A Cantos, D.M.D.
• Jeffrey Isaac Cantrell, MSN, PMHNP-BC
• Alexander Cantres
• Marietta Cantsee
• Avelina Cantu, PT, DPT
• David Cantu
• Isaiah Cantu

• Geriatric Medicine (Internal Medicine) Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Geriatric Medicine (Internal Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.