Basic Information
| Provider Information | |||||||||
| NPI: | 1588920581 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UNGOS | ||||||||
| FirstName: | ORLANDO | ||||||||
| MiddleName: | GUBA | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12021 WILSHIRE BLVD # 745 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900251206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669686380 | ||||||||
| FaxNumber: | 3106269765 | ||||||||
| Practice Location | |||||||||
| Address1: | 12021 WILSHIRE BLVD # 745 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900251206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669686380 | ||||||||
| FaxNumber: | 3106269765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2012 | ||||||||
| LastUpdateDate: | 04/04/2012 | ||||||||
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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 | 363A00000X | 22190 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.