Organization
MEDICAL BASE PHARMACY/DME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRINIDAD M. BAGOYO RPH (PRESIDENT)
(626) 215-2268
Entity
Organization
Contact information
Practice address
11135 RUSH ST, SUITE #H, SOUTH EL MONTE, CA 91733-3511
(626) 215-2268
Mailing address
11135 RUSH ST, SUITE #H, SOUTH EL MONTE, CA 91733-3511
(626) 215-2268
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
RPH 22293
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396921169
NPI
CA
Enumeration date
02/19/2008
Last updated
02/19/2008
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