Healthcare Provider Details

I. General information

NPI: 1235994534
Provider Name (Legal Business Name): MARIAN ESKANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17025 SIERRA LAKES PKWY
FONTANA CA
92336-1274
US

IV. Provider business mailing address

1826 ANITA CREST DR
ARCADIA CA
91006-1608
US

V. Phone/Fax

Practice location:
  • Phone: 909-355-3299
  • Fax:
Mailing address:
  • Phone: 626-716-0926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number109417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: