Individual provider Active NPI

Bryan Raul Cuadra, PA-C

  • Physician Assistant
  • Los Angeles, CA
National Provider Identifier
1962281527
Registry record updated Oct 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1207074 Issued in CA
Practice address
3255 Wilshire Blvd Ste 100
Los Angeles, CA 90010-1405
Phone
(213) 235-2500
NPI assigned
Sep 25, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1207074 CA Primary

Addresses

Primary practice location

3255 Wilshire Blvd Ste 100
Los Angeles, CA 90010-1405

Mailing address

3727 W 6TH St Ste 210
Los Angeles, CA 90020-5108
Phone (213) 235-2500

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231229002616 CA Practitioner - Physician Assistant 0749630929 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1207074CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Korean Health Education Information and Research Center CurrentSince Nov 14, 2023 Accepting new patients
Korean Health Education Information and Research Center CurrentSince Oct 22, 2023 Accepting new patients
Korean Health, Education, Information and Research Center CurrentSince Nov 14, 2023 Accepting new patients

Locations

3727 W 6th St
Ste 200
Los Angeles, CA 90020
Phone (213) 235-2500

3727 W 6th St
Ste 210
Los Angeles, CA 90020
Phone (213) 235-2500

3255 Wilshire Blvd
Ste 100
Los Angeles, CA 90010
Phone (213) 235-1203

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1695600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697760000000",
    "number": "1962281527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3727 W 6TH ST STE 210",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900205108",
            "telephone_number": "213-235-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3255 WILSHIRE BLVD STE 100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900101405",
            "telephone_number": "213-235-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUADRA",
        "first_name": "BRYAN",
        "middle_name": "RAUL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-25",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "1207074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.