Provider Demographics
NPI:1255358214
Name:ORLANDO H. PILE,MD A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:ORLANDO H. PILE,MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:H
Authorized Official - Last Name:PILE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-674-7453
Mailing Address - Street 1:140 W QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1726
Mailing Address - Country:US
Mailing Address - Phone:310-674-7453
Mailing Address - Fax:310-672-7264
Practice Address - Street 1:140 W QUEEN ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1726
Practice Address - Country:US
Practice Address - Phone:310-674-7453
Practice Address - Fax:310-672-7264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207R00000X207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A320290Medicaid
CAA26675Medicare UPIN
CAA32029Medicare ID - Type Unspecified