=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922303163
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD A VERDUGO DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2011
-----------------------------------------------------
Last Update Date | 01/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8515 FLORENCE AVE
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90240-4043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-869-4532
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 245 ENCANTADO CYN
-----------------------------------------------------
City | RANCHO SANTA MARGARITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92688-2997
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-939-8498
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 27570
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------