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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