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General NPI Number Information
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NPI Number | 1417179185
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Entity Type | Organization
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Legal Business Name | E.VICENCIO-QUEVEDO M.D. INC.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 02/06/2009
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Provider Practice Location Address
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Address Line | 709 E COLORADO BLVD #160
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City | PASADENA
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State | CA
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Zip | 91101-2125
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Country | US
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Telephone | 818-822-8317
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Fax | 626-793-7580
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Provider Business Mailing Address
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Address Line | 709 E COLORADO BLVD #160
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City | PASADENA
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State | CA
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Zip | 91101-2125
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Country | US
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Telephone | 818-822-8317
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Fax | 626-793-7580
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDUARDITA E VICENCIO-QUEVEDO
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Credential | M.D.
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Telephone | 818-822-8317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A23710
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License Number State | CA
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