Healthcare Provider Details

I. General information

NPI: 1619291473
Provider Name (Legal Business Name): ALMA ADRIANA AVENDANO DA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5807 N FIGUEROA ST
HIGHLAND PARK CA
90042-4227
US

IV. Provider business mailing address

1250 S FETTERLY AVE
LOS ANGELES CA
90022-3708
US

V. Phone/Fax

Practice location:
  • Phone: 323-982-0999
  • Fax: 323-982-0350
Mailing address:
  • Phone: 323-896-7365
  • Fax: 323-263-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: