Healthcare Provider Details

I. General information

NPI: 1962074187
Provider Name (Legal Business Name): MICHELE KRAMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 S ALAMEDA ST
COMPTON CA
90220-4976
US

IV. Provider business mailing address

11915 KLING ST APT 9
VALLEY VILLAGE CA
91607-4041
US

V. Phone/Fax

Practice location:
  • Phone: 310-627-5600
  • Fax:
Mailing address:
  • Phone: 818-740-1905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: