MEDICARE: DR. LEONOR CAPISTRANO ESLAO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	25885	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25885	OTHER		CAUE
2	B-25885-01	OTHER		DENTICAR

General Provider Information

NPI Number	:	1336137520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONOR CAPISTRANO ESLAO DMD

Provider Business Mailing Address
First Line	:	3120 W 6TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1702
Country	:	US
Telephone Number	:	213-385-0871
Fax Number	:	213-386-0923

Provider Business Practice Location Address
First Line	:	3120 W 6TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1702
Country	:	US
Telephone Number	:	213-385-0871
Fax Number	:	213-386-0923

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	07/08/2007

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