| NPI | 1528448313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GABRIELA CORONADO Office Manager 310-515-5505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 44959) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 44959) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2022-07-21 |