Provider Demographics
NPI:1841390739
Name:PANES, MARIANO PANELO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIANO
Middle Name:PANELO
Last Name:PANES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5417 PACIFIC BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-2532
Mailing Address - Country:US
Mailing Address - Phone:323-923-3838
Mailing Address - Fax:323-923-3838
Practice Address - Street 1:5417 PACIFIC BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2532
Practice Address - Country:US
Practice Address - Phone:323-923-3838
Practice Address - Fax:323-923-3838
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine