| Ernesto B. Banaag, M.d., Inc. | |
|
4034 Verdugo Rd Los Angeles CA 90065-3727 | |
| (323) 254-1987 | |
| (323) 254-3674 |
| Full Name | Ernesto B. Banaag, M.d., Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 4034 Verdugo Rd, Los Angeles, California |
| Authorized Official Name and Position | Ernesto Belmonte Banaag (PRESIDENT) |
| Authorized Official Contact | 3232541987 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ernesto B. Banaag, M.d., Inc. 4034 Verdugo Rd Los Angeles CA 90065-3727 Ph: (323) 254-1987 | Ernesto B. Banaag, M.d., Inc. 4034 Verdugo Rd Los Angeles CA 90065-3727 Ph: (323) 254-1987 |
| NPI Number | 1417010380 |
|---|---|
| Provider Enumeration Date | 12/19/2006 |
| Last Update Date | 11/13/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417010380 | NPI | - | NPPES |
| W20256 | Other | CA | MEDICARE GROUP ID |
| WA36730A | Other | CA | MEDICARE PPIN |
| 00A367300 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A36730 (California) | Primary |
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