Licuanan, Jesus Lomibao

Licuanan, Jesus Lomibao is an individual health care provider with primary practice located at 6131 Orangethorpe Ave Suite 215, Buena Park CA 90620-1315. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Licuanan, Jesus Lomibao can be contacted via phone (714) 521-1700.

Contact Information

Primary practice address
6131 Orangethorpe Ave Suite 215 Buena Park CA 90620-1315
Phone: (714) 521-1700
Fax: (714) 521-1003
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X

Profile Details

NPI number 1306897780
LBN Legal business name Licuanan, Jesus Lomibao
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 12th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306897780 NPPES
California MEDICAID 00A423000

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