Provider Demographics
NPI:1558540047
Name:TOVAR, ROGER MARQUEZ (TECHNICIAN)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:MARQUEZ
Last Name:TOVAR
Suffix:
Gender:M
Credentials:TECHNICIAN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5944 PENNSWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1231
Mailing Address - Country:US
Mailing Address - Phone:562-461-2168
Mailing Address - Fax:562-164-2160
Practice Address - Street 1:5944 PENNSWOOD AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1231
Practice Address - Country:US
Practice Address - Phone:562-461-2168
Practice Address - Fax:562-461-2160
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG113Medicare PIN