Healthcare Provider Details

I. General information

NPI: 1366929481
Provider Name (Legal Business Name): ESTELA RAMIREZ-COTONIETO I RDA 58449
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2018
Last Update Date: 07/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 N AZUSA AVE STE C
COVINA CA
91722-1257
US

IV. Provider business mailing address

3815 BALDWIN AVE APT 96
EL MONTE CA
91731-1736
US

V. Phone/Fax

Practice location:
  • Phone: 626-506-2216
  • Fax:
Mailing address:
  • Phone: 626-825-0465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number58449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: