Provider Demographics
NPI:1457320673
Name:PORCIUNCULA, GENEROSO PIGUING (MD)
Entity Type:Individual
Prefix:DR
First Name:GENEROSO
Middle Name:PIGUING
Last Name:PORCIUNCULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 W TENNYSON RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-4400
Mailing Address - Country:US
Mailing Address - Phone:510-887-6956
Mailing Address - Fax:510-887-2493
Practice Address - Street 1:1251 W TENNYSON RD
Practice Address - Street 2:SUITE 4
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-4400
Practice Address - Country:US
Practice Address - Phone:510-887-6956
Practice Address - Fax:510-887-2493
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36153207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A361530Medicaid
942775559OtherFEDERAL TAX ID NUMBER
A27993Medicare UPIN
CA00A361530Medicaid