Healthcare Provider Details

I. General information

NPI: 1164041331
Provider Name (Legal Business Name): SONRISAS LATINAS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8648 WOODMAN AVE UNIT 106
ARLETA CA
91331-6503
US

IV. Provider business mailing address

8648 WOODMAN AVE UNIT 106
ARLETA CA
91331-6503
US

V. Phone/Fax

Practice location:
  • Phone: 818-830-2866
  • Fax: 818-830-2856
Mailing address:
  • Phone: 818-830-2866
  • Fax: 818-830-2856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL LEPERA
Title or Position: PROVIDER
Credential: MD
Phone: 818-830-2866