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General NPI Number Information
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NPI Number | 1962412643
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Entity Type | Organization
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Legal Business Name | A DE LA PENA M D A MEDICAL GROUP INC
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 139 S ALVARADO ST
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City | LOS ANGELES
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State | CA
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Zip | 90057-2201
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Country | US
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Telephone | 213-484-0170
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Fax | 213-484-0246
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Provider Business Mailing Address
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Address Line | 2446 W WHITTIER BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-3041
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Country | US
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Telephone | 323-728-5500
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Fax | 323-728-4408
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Authorized Official
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Title or Position | OWNER
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Name | ALBERT DE LA PENA
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Credential | M.D.
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Telephone | 323-728-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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