Healthcare Provider Details

I. General information

NPI: 1184854671
Provider Name (Legal Business Name): EDICO HEALTH CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737 E. WASHINGTON BLVD.
PASADENA CA
91104
US

IV. Provider business mailing address

1737 E WASHINGTON BLVD
PASADENA CA
91104-2768
US

V. Phone/Fax

Practice location:
  • Phone: 626-794-1570
  • Fax:
Mailing address:
  • Phone: 626-794-1570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARCIANO PINGUE TAMAYO
Title or Position: VP FOR OPERATIONS
Credential:
Phone: 626-794-1570