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General NPI Number Information
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NPI Number | 1154403392
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Entity Type | Organization
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Legal Business Name | MARIANO P. PANES MD INC
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3004 WHITTIER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90023-1637
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Country | US
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Telephone | 323-261-8427
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Fax | 323-262-3502
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Provider Business Mailing Address
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Address Line | 3004 WHITTIER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90023-1637
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Country | US
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Telephone | 323-261-8427
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Fax | 323-262-3502
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIANO PANELO PANES
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Credential | M.D.
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Telephone | 323-261-8427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A36270
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License Number State | CA
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