Healthcare Provider Details

I. General information

NPI: 1336748896
Provider Name (Legal Business Name): CYNTHIA GARCIA MACDOUGALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CYNTHIA GARCIA MACDOUGALL RDHAP, BS

II. Dates (important events)

Enumeration Date: 10/25/2020
Last Update Date: 01/23/2021
Certification Date: 01/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 HERMOSA AVE APT 302
HERMOSA BEACH CA
90254-4433
US

IV. Provider business mailing address

444 HERMOSA AVE APT 302
HERMOSA BEACH CA
90254-4433
US

V. Phone/Fax

Practice location:
  • Phone: 310-376-9001
  • Fax:
Mailing address:
  • Phone: 310-376-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number23320
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: