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Organization
JESSE J LICUANAN MD A MEDICAL CORPORATION
Active
Organization
JESSE J LICUANAN MD A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSE J. LICUANAN MD (PRESIDENT/OWNER)
(562) 531-0377
Entity
Organization
Contact information
Practice address
3300 E SOUTH ST, SUITE 205, LAKEWOOD, CA 90805-4549
(562) 531-0377
(562) 531-1724
Mailing address
8251 LA PALMA AVE, SUITE 434, BUENA PARK, CA 90620-3205
(562) 531-0377
(562) 531-1724
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
04/19/2011
Last updated
04/19/2011
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