Healthcare Provider Details

I. General information

NPI: 1659632099
Provider Name (Legal Business Name): REBECCA ALMONEDA RATON D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23405 MAIN ST
CARSON CA
90745-5231
US

IV. Provider business mailing address

23405 MAIN ST
CARSON CA
90745-5231
US

V. Phone/Fax

Practice location:
  • Phone: 310-835-5373
  • Fax: 424-203-6516
Mailing address:
  • Phone: 310-835-5373
  • Fax: 424-203-6516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number45180
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: