Provider Demographics
NPI:1215985536
Name:ASENIERO, JESUS C (MD)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:C
Last Name:ASENIERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5953 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-3133
Mailing Address - Country:US
Mailing Address - Phone:323-562-6170
Mailing Address - Fax:323-562-6177
Practice Address - Street 1:5953 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-3133
Practice Address - Country:US
Practice Address - Phone:323-562-6170
Practice Address - Fax:323-562-6177
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42705208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A427050Medicaid
CA00A427050Medicaid
CAF73239Medicare UPIN