MEDICARE: MARIANO P. PANES MD INC

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	207R00000X	Internal Medicine Physician	A36270	CA

General Provider Information

NPI Number	:	1154403392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIANO P. PANES MD INC

Provider Business Mailing Address
First Line	:	3004 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1637
Country	:	US
Telephone Number	:	323-261-8427
Fax Number	:	323-262-3502

Provider Business Practice Location Address
First Line	:	3004 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1637
Country	:	US
Telephone Number	:	323-261-8427
Fax Number	:	323-262-3502

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARIANO PANELO PANES
Credential	:	M.D.
Telephone Number	:	323-261-8427

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	08/22/2020

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