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Organization
MEDARDO C. SUPNET, M.D., INC
Active
Organization
MEDARDO C. SUPNET, M.D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEDARDO CABASA SUPNET M.D. (OWNER)
(562) 864-7279
Entity
Organization
Contact information
Practice address
11637 THE PLAZA, NORWALK, CA 90650-3930
(562) 864-7279
(562) 406-8606
Mailing address
11637 THE PLAZA, NORWALK, CA 90650-3930
(562) 864-7279
(562) 406-8606
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
GR0101320
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A462030
MEDICAL RENDERING PROVIDER NUMBER
CA
01
—
00A501250
MEDICAL RENDERING PROVIDER NUMBER
CA
01
—
PA16910
PHYSICIAN ASSISTANT PROVIDER NUMBER
CA
Enumeration date
08/31/2006
Last updated
08/29/2008
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