MEDICARE: MS. ELAINE ARIPEZ RDA

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	58699	CA

General Provider Information

NPI Number	:	1548534613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELAINE ARIPEZ RDA

Provider Business Mailing Address
First Line	:	2442 CHESTNUT AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2913
Country	:	US
Telephone Number	:	562-810-8364
Fax Number	:

Provider Business Practice Location Address
First Line	:	6255 W SUNSET BLVD FL 21
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7422
Country	:	US
Telephone Number	:	323-462-6869
Fax Number	:

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

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	12/17/2013

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