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General NPI Number Information
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NPI Number | 1336240217
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Entity Type | Organization
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Legal Business Name | LIDEIA N. ITCHON, M.D. INC.
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 25835 NARBONNE AVE STE 260
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City | LOMITA
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State | CA
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Zip | 90717-3085
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Country | US
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Telephone | 310-517-0977
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Fax | 310-517-9811
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Provider Business Mailing Address
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Address Line | 25835 NARBONNE AVE STE 260
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City | LOMITA
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State | CA
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Zip | 90717-3085
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Country | US
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Telephone | 310-517-0977
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Fax | 310-517-9811
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LIDEIA NAVASCA ITCHON
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Credential | M.D.
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Telephone | 310-517-0977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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