MEDICARE: ANGELICA DUENAS M.D.

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	207R00000X	Internal Medicine Physician	A62406	CA

General Provider Information

NPI Number	:	1619982311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELICA DUENAS M.D.

Provider Business Mailing Address
First Line	:	578 WASHINGTON BLVD
Second Line	:	SUITE # 825
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-5421
Country	:	US
Telephone Number	:	310-600-2787
Fax Number	:	310-306-4852

Provider Business Practice Location Address
First Line	:	578 WASHINGTON BLVD
Second Line	:	SUITE # 825
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-5421
Country	:	US
Telephone Number	:	310-600-2787
Fax Number	:	310-306-4852

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	07/08/2007

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