=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659530749
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANASTACIO C PINZON M.D. INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2008
-----------------------------------------------------
Last Update Date | 01/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2252 BEVERLY BLVD STE 101
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90057-2235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-487-6157
-----------------------------------------------------
Fax | 213-487-1177
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2252 BEVERLY BLVD STE 101
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90057-2235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-487-6157
-----------------------------------------------------
Fax | 213-487-1177
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE ADMINISTRATOR
-----------------------------------------------------
Name | DELINIA ALFARO PINZON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-487-6751
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | A328250
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------