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General NPI Number Information
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NPI Number | 1073687851
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Entity Type | Organization
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Legal Business Name | EFRAIN MASCARENO OD APC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 04/17/2013
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Provider Practice Location Address
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Address Line | 440 4TH AVE
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City | CHULA VISTA
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State | CA
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Zip | 91910-4443
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Country | US
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Telephone | 619-427-2020
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Fax | 866-254-5707
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Provider Business Mailing Address
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Address Line | 440 4TH AVE
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City | CHULA VISTA
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State | CA
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Zip | 91910-4443
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Country | US
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Telephone | 619-427-2020
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Fax | 866-254-5707
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EFRAIN MASCARENO
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Credential | OD
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Telephone | 619-427-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 10906T
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License Number State | CA
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