Healthcare Provider Details

I. General information

NPI: 1871703926
Provider Name (Legal Business Name): NADA J TRABOULSI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E BIRCH ST STE 102
BREA CA
92821-5155
US

IV. Provider business mailing address

1220 E BIRCH ST STE 102
BREA CA
92821-5155
US

V. Phone/Fax

Practice location:
  • Phone: 714-529-4477
  • Fax: 714-529-7031
Mailing address:
  • Phone: 714-529-4477
  • Fax: 714-529-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number38377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: