Provider Demographics
NPI:1073522769
Name:M L BANIGO MD INC
Entity Type:Organization
Organization Name:M L BANIGO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAY
Authorized Official - Middle Name:LOLO
Authorized Official - Last Name:BANIGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-845-6206
Mailing Address - Street 1:101 S 1ST ST
Mailing Address - Street 2:1000
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1938
Mailing Address - Country:US
Mailing Address - Phone:818-845-6206
Mailing Address - Fax:818-845-9774
Practice Address - Street 1:900 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4716
Practice Address - Country:US
Practice Address - Phone:626-570-9000
Practice Address - Fax:626-570-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A661850Medicaid
CA00A661850OtherBLUE SHIELD
CA00A661850OtherBLUE SHIELD
CAA66185Medicare PIN