Basic Information
| Provider Information | |||||||||
| NPI: | 1073522769 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | M L BANIGO MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 S 1ST ST | ||||||||
| Address2: | 1000 | ||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915021938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188456206 | ||||||||
| FaxNumber: | 8188459774 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 S ATLANTIC BLVD | ||||||||
| Address2: | |||||||||
| City: | MONTEREY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917544716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265709000 | ||||||||
| FaxNumber: | 6265705775 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 03/02/2011 | ||||||||
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| AuthorizedOfficialLastName: | BANIGO | ||||||||
| AuthorizedOfficialFirstName: | MAY | ||||||||
| AuthorizedOfficialMiddleName: | LOLO | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8188456206 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 00A661850 | 05 | CA | MEDICAID | 00A661850 | 01 | CA | BLUE SHIELD | OTHER |