Healthcare Provider Details

I. General information

NPI: 1841891314
Provider Name (Legal Business Name): NELDA AMINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11635 SOUTH ST
ARTESIA CA
90701-6628
US

IV. Provider business mailing address

706 WYCLIFFE
IRVINE CA
92602-1217
US

V. Phone/Fax

Practice location:
  • Phone: 310-409-4265
  • Fax:
Mailing address:
  • Phone: 713-330-5444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS105642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: