MEDARDO C. SUPNET M.D. INC NPI 1417069303

NPI Information

  • NPI: 1417069303
  • Provider Name: MEDARDO C. SUPNET, M.D., INC
  • Classification: Specialist - 174400000X
  • Entity Type: Organization
  • CLIA Number: 05D1029375
  • Address: 11637 THE PLAZA
    NORWALK, CA
    ZIP 90650
  • Phone: (562) 864-7279

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NPI Details

MEDARDO C. SUPNET, M.D., INC is a specialist in Norwalk, CA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. MEDARDO C. SUPNET, M.D., INC NPI is 1417069303. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

11637 THE PLAZA
NORWALK, CA
ZIP 90650-930
Phone: (562) 864-7279
Fax: (562) 406-8606

The provider's authorized official is Medardo Cabasa Supnet .
The authorized official title is Owner and has the following contact phone number (562) 864-7279.

The CLIA number assigned to this NPI record is 05D1029375 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/31/2006 and was last updated on 8/29/2008.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistGR0101320CALIFORNIAYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100A462030OTHERCALIFORNIAMEDICAL RENDERING PROVIDER NUMBER
2PA16910OTHERCALIFORNIAPHYSICIAN ASSISTANT PROVIDER NUMBER
300A501250OTHERCALIFORNIAMEDICAL RENDERING PROVIDER NUMBER

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: 11/21/2025

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