Basic Information
| Provider Information | |||||||||
| NPI: | 1306039318 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COMPOGINIS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1044 S FAIR OAKS AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911052622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264494859 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1044 S FAIR OAKS AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911052622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264494859 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 06/30/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | A105902 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.