| NPI | 1093250961 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELVA MATA Office Administrator 310-545-5757 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: CA 41617) |
| Enumeration Date | 2016-12-30 |
| Last Update Date | 2016-12-30 |