Individual
DR. CAROLINE MARIE LICUD AVENTURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1300 S SUNSET AVE, WEST COVINA, CA 91790-3342
(626) 338-9915
Mailing address
2040 CAMFIELD AVE, COMMERCE, CA 90040-1502
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301084039
MI
207Q00000X
Family Medicine Physician
Primary
A102553
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W14158
SITE PTAN
CA
01
—
ZZZ20041Z
SITE PTAN
CA
Enumeration date
05/01/2007
Last updated
07/24/2014
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