MEDICARE: MDNP PROVIDERS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician
2	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1144659228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDNP PROVIDERS INC

Provider Business Mailing Address
First Line	:	596 N LAKE AVE STE 203
Second Line	:	203
City	:	PASADENA
State	:	CA
Zip	:	91101-1222
Country	:	US
Telephone Number	:	714-408-6522
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 W BEVERLY BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-4305
Country	:	US
Telephone Number	:	909-576-8889
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GINA CASTROMAYOR
Credential	:	RN
Telephone Number	:	714-408-6522

Provider Enumeration Date	:	11/08/2013
Last Update Date	:	12/10/2013

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Directions to “MDNP PROVIDERS INC ” Practice Location

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