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MEDARDO SUPNET M.D. INC NPI 1003089970


NPI Information

NPI: 1003089970
Provider Name: MEDARDO SUPNET M.D. INC
Classification: Legal Medicine - 173000000X
Entity Type: Organization

CLIA Number: 05D0893428

Address:
3585 E IMPERIAL HWY
LYNWOOD, CA
ZIP 90262
Phone: (310) 605-4260
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MEDARDO SUPNET M.D. INC is a legal medicine in Lynwood, CA. The provider is the specialty areas of medicine concerned with matters of, and relations with, substantive law and legal institutions; such as the conduct of medical examinations at crime scenes, performance of autopsies, giving of expert medical testimony in judicial proceedings, medical treatment of inmates of penal institutions, the practice of trauma medicine in law enforcement settings, and other clinical practice and medical science applications in the fields of law, law enforcement, and corrections. MEDARDO SUPNET M.D. INC NPI is 1003089970. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3585 E IMPERIAL HWY
LYNWOOD, CA
ZIP 90262-654
Phone: (310) 605-4260
Fax: (310) 605-4263

The provider's authorized official is Meliza Dayrit .
The authorized official title is Office Manager and has the following contact phone number (310) 605-4260.

The CLIA number assigned to this NPI record is 05D0893428 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/10/2008 and was last updated on 4/10/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1173000000XLegal MedicineA46203CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11417069303MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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