MEDICARE: DR. JOHN COMPAGNO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G38126	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134125578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN COMPAGNO

Provider Business Mailing Address
First Line	:	712 ALFRED NOBEL DR
Second Line	:
City	:	HERCULES
State	:	CA
Zip	:	94547-1805
Country	:	US
Telephone Number	:	510-662-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	712 ALFRED NOBEL DR
Second Line	:
City	:	HERCULES
State	:	CA
Zip	:	94547-1805
Country	:	US
Telephone Number	:	510-662-5200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/09/2007

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Directions to “ DR. JOHN COMPAGNO ” Practice Location

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