MEDICARE: MR. EFREN SISON VALENZUELA M.D.

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	208000000X	Pediatrics Physician	A40381	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	:	1699705822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EFREN SISON VALENZUELA M.D.

Provider Business Mailing Address
First Line	:	1704 W MANCHESTER AVE
Second Line	:	SUITE 101
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-3034
Country	:	US
Telephone Number	:	323-778-6215
Fax Number	:	323-778-6312

Provider Business Practice Location Address
First Line	:	1704 W MANCHESTER AVE
Second Line	:	SUITE 101
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-3034
Country	:	US
Telephone Number	:	323-778-6215
Fax Number	:	323-778-6312

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. EFREN SISON VALENZUELA M.D.” Practice Location

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