| Jed Padre Md Inc | |
|
282 E Sepulveda Blvd Carson CA 90745-6323 | |
| (310) 518-6861 | |
| (310) 835-1366 |
| Full Name | Jed Padre Md Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 282 E Sepulveda Blvd, Carson, California |
| Authorized Official Name and Position | Jed Padre (OWNER) |
| Authorized Official Contact | 3105186861 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jed Padre Md Inc 282 E Sepulveda Blvd Carson CA 90745-6323 Ph: (310) 518-6861 | Jed Padre Md Inc 282 E Sepulveda Blvd Carson CA 90745-6323 Ph: (310) 518-6861 |
| NPI Number | 1225643448 |
|---|---|
| Provider Enumeration Date | 09/14/2020 |
| Last Update Date | 09/14/2020 |
| Medicare PECOS PAC ID | 4981023140 |
|---|---|
| Medicare Enrollment ID | O20201007003072 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225643448 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jed Padre |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285169110 PECOS PAC ID: 1456623479 Enrollment ID: I20201007003132 |
| Provider Name | Diane Padre-gozun |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457858714 PECOS PAC ID: 6204233406 Enrollment ID: I20210929003585 |
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