MEDICARE: MRS. ARACELI ALCARAZ CANO 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	RDA 78437	CA

General Provider Information

NPI Number	:	1801222351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ARACELI ALCARAZ CANO RDA

Provider Business Mailing Address
First Line	:	3980 DALTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90062-1214
Country	:	US
Telephone Number	:	323-590-8013
Fax Number	:

Provider Business Practice Location Address
First Line	:	3980 DALTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90062-1214
Country	:	US
Telephone Number	:	323-590-8013
Fax Number	:

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

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	09/16/2013

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