Individual
JESUS LOMIBAO LICUANAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6131 ORANGETHORPE AVE, SUITE 215, BUENA PARK, CA 90620-1315
(714) 521-1700
(714) 521-1003
Mailing address
6131 ORANGETHORPE AVE, SUITE 215, BUENA PARK, CA 90620-1315
(714) 521-1700
(714) 521-1003
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A423000
—
CA
Enumeration date
05/12/2006
Last updated
07/08/2007
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