Healthcare Provider Details

I. General information

NPI: 1417432782
Provider Name (Legal Business Name): HUGO CORDON HAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 WOODRUFF AVE STE 411
LONG BEACH CA
90808-2146
US

IV. Provider business mailing address

3816 WOODRUFF AVE STE 411
LONG BEACH CA
90808-2146
US

V. Phone/Fax

Practice location:
  • Phone: 562-606-1033
  • Fax:
Mailing address:
  • Phone: 562-606-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number108325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: