Healthcare Provider Details

I. General information

NPI: 1588951404
Provider Name (Legal Business Name): MANUEL I FIGUEROA M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 STATE ST
HUNTINGTON PARK CA
90255-5823
US

IV. Provider business mailing address

7301 STATE ST
HUNTINGTON PARK CA
90255-5823
US

V. Phone/Fax

Practice location:
  • Phone: 323-581-5120
  • Fax: 323-581-5148
Mailing address:
  • Phone: 323-581-5120
  • Fax: 323-581-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA21870
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA90745
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA32930
License Number StateCA

VIII. Authorized Official

Name: VICKY PINEDA
Title or Position: CREDENTIALING ADMIN
Credential:
Phone: 562-445-7870