Healthcare Provider Details

I. General information

NPI: 1730306671
Provider Name (Legal Business Name): MR. ARSENIO TAGORDA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 E CARSON ST
CARSON CA
90745-2720
US

IV. Provider business mailing address

8063 FELIX AVE
BELL GARDENS CA
90201-6205
US

V. Phone/Fax

Practice location:
  • Phone: 310-830-8927
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number20333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: