Provider Demographics
NPI:1235312752
Name:ANORGA, EDUARDO JOAQUIN (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:JOAQUIN
Last Name:ANORGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 S PROSTECT AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277
Mailing Address - Country:US
Mailing Address - Phone:310-944-9344
Mailing Address - Fax:310-944-9390
Practice Address - Street 1:1970 S PROSPECT AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-6005
Practice Address - Country:US
Practice Address - Phone:310-944-9344
Practice Address - Fax:310-944-9390
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13994OtherMEDICARE GROUP
CAW13994OtherMEDICARE GROUP
CAWG56001DMedicare PIN