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General NPI Number Information
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NPI Number | 1093144172
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Entity Type | Organization
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Legal Business Name | PEXICO, INC.
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 275 WEST SAN BERNARDINO RD.
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City | COVINA
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State | CA
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Zip | 91723
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Country | US
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Telephone | 818-956-5686
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 1993
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City | GLENDALE
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State | CA
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Zip | 91209
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Country | US
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Telephone | 818-956-5686
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LUZ SAEDIFAR
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Credential |
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Telephone | 818-956-5686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 500283
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License Number State | CA
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