Healthcare Provider Details

I. General information

NPI: 1134217052
Provider Name (Legal Business Name): ROANNA SIANGIO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9474 FIRESTONE BLVD
DOWNEY CA
90241-5504
US

IV. Provider business mailing address

12129 YEARLING ST
CERRITOS CA
90703-7617
US

V. Phone/Fax

Practice location:
  • Phone: 562-803-4224
  • Fax:
Mailing address:
  • Phone: 562-924-9549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: