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Organization
SAN ANTONIO LENNOX
Active
Organization
SAN ANTONIO LENNOX
Active
Other names
MANUEL ACEVEDO
Organization subpart
No
Provider details
NPI number
Authorized official
MANUEL ERNESTO ACEVEDO M.D (MEDICAL DIRECTOR)
(310) 673-1922
Entity
Organization
Contact information
Practice address
10811 S GREVILLEA AVE, LENNOX, CA 90304-2325
(310) 673-1922
(310) 673-7701
Mailing address
PO BOX 1045, HAWTHORNE, CA 90251-1045
(310) 679-1922
(310) 673-7701
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A74961
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336251032
NPI
CA
Enumeration date
09/04/2007
Last updated
09/04/2007
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