Healthcare Provider Details

I. General information

NPI: 1912185281
Provider Name (Legal Business Name): CELIA DE GUZMAN BETO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22106 S MAIN ST
CARSON CA
90745
US

IV. Provider business mailing address

PO BOX 13002
TORRANCE CA
90503
US

V. Phone/Fax

Practice location:
  • Phone: 310-834-8422
  • Fax:
Mailing address:
  • Phone: 310-834-8422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: