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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 C SUPNET M.D. (OWNER)
(310) 605-4260
Entity
Organization
Contact information
Practice address
3585 E IMPERIAL HWY, LYNWOOD, CA 90262-2654
(310) 605-4260
(310) 605-4263
Mailing address
3585 E IMPERIAL HWY, LYNWOOD, CA 90262-2654
(310) 605-4260
(310) 605-4263
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A46203
CA
174400000X
Specialist
A50125
CA
363AM0700X
Medical Physician Assistant
PA16910
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
09/08/2008
Last updated
09/08/2008
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