Healthcare Provider Details

I. General information

NPI: 1083837769
Provider Name (Legal Business Name): MARIA TERESA MANTUANO YEPIZ DENTIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 W ARTESIA BLVD SUITE 6
GARDENA CA
90248-3232
US

IV. Provider business mailing address

9435 HEINER ST
BELLFLOWER CA
90706-3059
US

V. Phone/Fax

Practice location:
  • Phone: 310-323-0290
  • Fax:
Mailing address:
  • Phone: 562-804-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41953
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: