Healthcare Provider Details

I. General information

NPI: 1528458130
Provider Name (Legal Business Name): AARON CONTRERAS I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N LONG BEACH BLVD
COMPTON CA
90221-1651
US

IV. Provider business mailing address

1515 N LONG BEACH BLVD
COMPTON CA
90221-1651
US

V. Phone/Fax

Practice location:
  • Phone: 310-365-1969
  • Fax:
Mailing address:
  • Phone: 310-365-1969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number62586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: