Healthcare Provider Details

I. General information

NPI: 1366728313
Provider Name (Legal Business Name): ARMANDO J ISLAS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 N AZUSA AVE SUITE A
AZUSA CA
91702-2968
US

IV. Provider business mailing address

PO BOX 2399
COVINA CA
91722-8399
US

V. Phone/Fax

Practice location:
  • Phone: 949-981-3515
  • Fax:
Mailing address:
  • Phone: 949-981-3515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number31479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: