Provider Demographics
NPI:1184854671
Name:EDICO HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:EDICO HEALTH CARE CORPORATION
Other - Org Name:EDICO PAIN MANAGEMENT AND REHABILITATION WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FOR OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCIANO
Authorized Official - Middle Name:PINGUE
Authorized Official - Last Name:TAMAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-794-1570
Mailing Address - Street 1:1737 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2768
Mailing Address - Country:US
Mailing Address - Phone:626-794-1570
Mailing Address - Fax:
Practice Address - Street 1:1737 E. WASHINGTON BLVD.
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104
Practice Address - Country:US
Practice Address - Phone:626-794-1570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty