=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639477185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALDEMAR ASCENCIO MD INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2011
-----------------------------------------------------
Last Update Date | 05/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23961 CALLE DE LA MAGDALENA #200
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-3616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-380-1006
-----------------------------------------------------
Fax | 949-380-7742
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23961 CALLE DE LA MAGDALENA #200
-----------------------------------------------------
City | LAGUNA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92653-3616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-380-1006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MD
-----------------------------------------------------
Name | DR. VALDEMAR ASCENCIO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 949-380-1006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | G31947
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------