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NPI Code Detail

MEDICARE: AZUCENA PORRAL M.D.

MEDICARE: AZUCENA PORRAL 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
12080A0000XPediatric Adolescent Medicine PhysicianA25493CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2A25493OTHERCADOCTORS STATE LICENSE

General Provider Information

NPI Number : 1881793743
Entity Type Code : Individual
Provider Name (Legal Business Name) : AZUCENA PORRAL M.D.
Provider Business Mailing Address
First Line : 5546 ROSEMEAD BLVD STE 102
Second Line :
City : TEMPLE CITY
State : CA
Zip : 91780-1855
Country : US
Telephone Number : 626-285-9600
Fax Number : 626-285-2214
Provider Business Practice Location Address
First Line : 5546 ROSEMEAD BLVD STE 102
Second Line :
City : TEMPLE CITY
State : CA
Zip : 91780-1855
Country : US
Telephone Number : 626-285-9600
Fax Number : 626-285-2214
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 07/08/2007

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Directions to “ AZUCENA PORRAL M.D.” Practice Location

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