Organization
MEDARDO SUPNET M.D. INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELIZA DAYRIT (OFFICE MANAGER)
(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
173000000X
Legal Medicine
Primary
A46203
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417069303
—
CA
Enumeration date
04/10/2008
Last updated
04/10/2008
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