| NPI | 1790201762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LIDYA SORAYA ACEVEDO Owner 323-724-1010 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 55423) |
| Enumeration Date | 2017-08-21 |
| Last Update Date | 2017-08-21 |