Organization
DECIO RANGEL, M.D., A PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DECIO RANGEL M.D. (OWNER)
(310) 828-7454
Entity
Organization
Contact information
Practice address
2001 SANTA MONICA BLVD STE 470W, SANTA MONICA, CA 90404-2181
(310) 828-7454
(310) 828-6362
Mailing address
2001 SANTA MONICA BLVD STE 470W, SANTA MONICA, CA 90404-2181
(310) 828-7454
(310) 828-6362
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A25197
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EA619A
MEDICARE GROUP PTAN
CA
Enumeration date
09/03/2014
Last updated
09/03/2014
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