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Medardo C. Supnet, M.d., Inc
Medical Physician Assistant in Lynwood, California
NPI 1699923235

Medardo C. Supnet, M.d., Inc is a Medical Physician Assistant based in Lynwood, CA and is specialized in Medical. Medardo C. Supnet, M.d., Inc practices in Lynwood, CA. The NPI Number for Medardo C. Supnet, M.d., Inc is 1699923235 and holds a License No. A50125 (California).

The current practice location address for Medardo C. Supnet, M.d., Inc is 3585 E Imperial Hwy, Lynwood, CA and can be reached out via phone at 310-605-4260 and via fax at 310-605-4263.

Location: 3585 E Imperial Hwy, Lynwood, CA, 90262-2654
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1699923235
Provider Name
Medardo C. Supnet, M.d., Inc
Credential
Provider Entity Type
Organization
Address
3585 E Imperial Hwy, Lynwood, CA, 90262-2654
Phone Number
310-605-4260
Fax Number
310-605-4263
Provider Enumeration Date
09/08/2008
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
PA16910 01 CA PHYSICIAN ASSISTANT PROVIDER NUMBER
00A462030 01 CA MEDICAL RENDERING PROVIDER NUMBER
00A501250 01 CA MEDICAL RENDERING PROVIDER NUMBER
institution
Provider Business Practice Location Address Details
Address
3585 E Imperial Hwy
City
Lynwood
State
California
Zip
90262-2654
Phone Number
310-605-4260
Fax Number
310-605-4263
person
Provider Business Mailing Address Details
Address
3585 E Imperial Hwy
City
Lynwood
State
California
Zip
90262-2654
Phone Number
310-605-4260
Fax Number
310-605-4263
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
A46203 (California)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
363AM0700X
License No.
A50125 (California)
Definition
Definition to come...
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