Provider Demographics
NPI:1508020322
Name:MARIO A. PACADA, DPM, INC
Entity Type:Organization
Organization Name:MARIO A. PACADA, DPM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:ANTONYO
Authorized Official - Last Name:PACADA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:562-209-0713
Mailing Address - Street 1:3756 SANTA ROSALIA DR STE 302
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3615
Mailing Address - Country:US
Mailing Address - Phone:562-208-0713
Mailing Address - Fax:562-684-0289
Practice Address - Street 1:3756 SANTA ROSALIA DR STE 302
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3615
Practice Address - Country:US
Practice Address - Phone:562-208-0713
Practice Address - Fax:562-684-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4163213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6075590001Medicare NSC