MEDICARE: MARIO A. PACADA, DPM, 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	213E00000X	Podiatrist	E4163	CA

General Provider Information

NPI Number	:	1508020322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIO A. PACADA, DPM, INC

Provider Business Mailing Address
First Line	:	3756 SANTA ROSALIA DR STE 302
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-3615
Country	:	US
Telephone Number	:	562-208-0713
Fax Number	:	562-684-0289

Provider Business Practice Location Address
First Line	:	3756 SANTA ROSALIA DR STE 302
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-3615
Country	:	US
Telephone Number	:	562-208-0713
Fax Number	:	562-684-0289

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARIO ANTONYO PACADA
Credential	:	DPM
Telephone Number	:	562-209-0713

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	07/10/2008

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