Organization Name: | RUBEN EZQUERRO DPM INC |
NPI Number: | 1184946386 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RUBEN EZQUERRO (OWNER) |
Mailing Address: | 21500 Pioneer Blvd Suite 107 Hawaiian Gardens |
State: | CA US |
Postal Code: | 907162600 |
Phone Number: | 5624025311 |
Fax Number: | 5624021407 |
NPI Enumeration Date: | 02/16/2010 |
NPI Last Update Date: | 10/09/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | E4042 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |