Provider Demographics
NPI:1639477185
Name:VALDEMAR ASCENCIO MD INC.
Entity Type:Organization
Organization Name:VALDEMAR ASCENCIO MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:VALDEMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ASCENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-380-1006
Mailing Address - Street 1:23961 CALLE DE LA MAGDALENA
Mailing Address - Street 2:#200
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3616
Mailing Address - Country:US
Mailing Address - Phone:949-380-1006
Mailing Address - Fax:
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA
Practice Address - Street 2:#200
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3616
Practice Address - Country:US
Practice Address - Phone:949-380-1006
Practice Address - Fax:949-380-7742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31947174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91382Medicare UPIN