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General NPI Number Information
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NPI Number | 1841780012
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Entity Type | Organization
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Legal Business Name | FERNANDO VERDUGO, DDS, CORP.
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 05/14/2018
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Provider Practice Location Address
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Address Line | 2028 LAKE AVE
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City | ALTADENA
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State | CA
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Zip | 91001-2450
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Country | US
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Telephone | 626-797-7551
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Fax |
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Provider Business Mailing Address
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Address Line | 6344 PRIMROSE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90068-2886
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FERNANDO VERDUGO
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Credential | DDS
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Telephone | 310-709-0193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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