Healthcare Provider Details

I. General information

NPI: 1841390739
Provider Name (Legal Business Name): MARIANO PANELO PANES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14461 MERCED AVE STE 203
BALDWIN PARK CA
91706-5174
US

IV. Provider business mailing address

14461 MERCED AVE STE 203
BALDWIN PARK CA
91706-5174
US

V. Phone/Fax

Practice location:
  • Phone: 626-960-5369
  • Fax: 626-814-2156
Mailing address:
  • Phone: 626-960-5369
  • Fax: 626-814-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA36270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: