MEDICARE: EDICO HEALTH CARE CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician
2	2083P0901X	Public Health & General Preventive Medicine Physician
3	208D00000X	General Practice Physician
4	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1184854671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDICO HEALTH CARE CORPORATION

Provider Business Mailing Address
First Line	:	1737 E WASHINGTON BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-2768
Country	:	US
Telephone Number	:	626-794-1570
Fax Number	:

Provider Business Practice Location Address
First Line	:	1737 E. WASHINGTON BLVD.
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104
Country	:	US
Telephone Number	:	626-794-1570
Fax Number	:

Authorized Official
Title or Position	:	VP FOR OPERATIONS
Name	:	MR. MARCIANO PINGUE TAMAYO
Credential	:
Telephone Number	:	626-794-1570

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	07/20/2009

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Directions to “EDICO HEALTH CARE CORPORATION ” Practice Location

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