Healthcare Provider Details

I. General information

NPI: 1629929674
Provider Name (Legal Business Name): EDUARDO M GABUTEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2026
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22015 MAIN ST
CARSON CA
90745-2942
US

IV. Provider business mailing address

22015 MAIN ST
CARSON CA
90745-2942
US

V. Phone/Fax

Practice location:
  • Phone: 310-834-8963
  • Fax: 310-834-7312
Mailing address:
  • Phone: 310-834-8963
  • Fax: 310-834-7312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EDUARDO M GABUTEN
Title or Position: DENTIST
Credential:
Phone: 310-834-8963