Healthcare Provider Details

I. General information

NPI: 1750797098
Provider Name (Legal Business Name): NAPOLEON TIQUIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12049 HARTDALE AVENUE
LA MIRADA CA
90638
US

IV. Provider business mailing address

12049 HARTDALE AVENUE
LA MIRADA CA
90638
US

V. Phone/Fax

Practice location:
  • Phone: 562-943-1573
  • Fax: 562-943-4320
Mailing address:
  • Phone: 562-943-1573
  • Fax: 562-943-4320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberAFE33499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: