MEDICARE: AARON CONTRERAS I

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	126800000X	Dental Assistant	62586	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B7493377	OTHER	CA	DL

General Provider Information

NPI Number	:	1528458130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON CONTRERAS I

Provider Business Mailing Address
First Line	:	1515 N LONG BEACH BLVD
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90221-1651
Country	:	US
Telephone Number	:	310-365-1969
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 N LONG BEACH BLVD
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90221-1651
Country	:	US
Telephone Number	:	310-365-1969
Fax Number	:

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

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	02/03/2015

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Directions to “ AARON CONTRERAS I ” Practice Location

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