Provider Demographics
NPI:1154403392
Name:MARIANO P. PANES MD INC
Entity type:Organization
Organization Name:MARIANO P. PANES MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANO
Authorized Official - Middle Name:PANELO
Authorized Official - Last Name:PANES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-261-8427
Mailing Address - Street 1:3004 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1637
Mailing Address - Country:US
Mailing Address - Phone:323-261-8427
Mailing Address - Fax:323-262-3502
Practice Address - Street 1:3004 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1637
Practice Address - Country:US
Practice Address - Phone:323-261-8427
Practice Address - Fax:323-262-3502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty