MEDICARE: MR. ROGER MARQUEZ TOVAR TECHNICIAN

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	2471V0105X	Vascular Sonography Radiologic Technologist

General Provider Information

NPI Number	:	1558540047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROGER MARQUEZ TOVAR TECHNICIAN

Provider Business Mailing Address
First Line	:	5944 PENNSWOOD AVE
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-1231
Country	:	US
Telephone Number	:	562-461-2168
Fax Number	:	562-164-2160

Provider Business Practice Location Address
First Line	:	5944 PENNSWOOD AVE
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-1231
Country	:	US
Telephone Number	:	562-461-2168
Fax Number	:	562-461-2160

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	10/31/2007

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