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General NPI Number Information
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NPI Number | 1417010380
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Entity Type | Organization
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Legal Business Name | ERNESTO B. BANAAG, M.D., INC.
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 4034 VERDUGO RD
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City | LOS ANGELES
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State | CA
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Zip | 90065-3727
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Country | US
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Telephone | 323-254-1987
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Fax | 323-254-3674
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Provider Business Mailing Address
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Address Line | 4034 VERDUGO RD
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City | LOS ANGELES
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State | CA
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Zip | 90065-3727
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Country | US
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Telephone | 323-254-1987
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Fax | 323-254-3674
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERNESTO BELMONTE BANAAG
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Credential | M.D.
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Telephone | 323-254-1987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A36730
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License Number State | CA
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