Healthcare Provider Details

I. General information

NPI: 1205449451
Provider Name (Legal Business Name): ROCIO FRIAS RDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 E ONTARIO AVE
CORONA CA
92881-8653
US

IV. Provider business mailing address

7950 ETIWANDA AVE APT 31207
RANCHO CUCAMONGA CA
91739-8730
US

V. Phone/Fax

Practice location:
  • Phone: 951-531-9504
  • Fax:
Mailing address:
  • Phone: 909-358-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberRDA63784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: