Provider Demographics
NPI:1336240217
Name:LIDEIA N. ITCHON, M.D. INC.
Entity Type:Organization
Organization Name:LIDEIA N. ITCHON, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIDEIA
Authorized Official - Middle Name:NAVASCA
Authorized Official - Last Name:ITCHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-517-0977
Mailing Address - Street 1:25835 NARBONNE AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-3085
Mailing Address - Country:US
Mailing Address - Phone:310-517-0977
Mailing Address - Fax:310-517-9811
Practice Address - Street 1:25835 NARBONNE AVE STE 260
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-3085
Practice Address - Country:US
Practice Address - Phone:310-517-0977
Practice Address - Fax:310-517-9811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty