Organization
JESUS L. LICUANAN, M.D. INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JESUS L LICUANAN M.D. (PRESIDENT/OWNER)
(714) 521-1700
Entity
Organization
Contact information
Practice address
6131 ORANGETHORPE AVE, # 215, BUENA PARK, CA 90620-1315
(714) 521-1700
(714) 521-1003
Mailing address
6131 ORANGETHORPE AVE, # 215, BUENA PARK, CA 90620-1315
(714) 521-1700
(714) 521-1003
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A42300
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A423000
BLUE SHIELD OF CALIFORNIA
CA
05
—
A42300
—
CA
01
—
AQ154
P-TAN
CA
Enumeration date
05/29/2008
Last updated
03/07/2023
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us