Healthcare Provider Details

I. General information

NPI: 1023288461
Provider Name (Legal Business Name): MARCELA GIRALDO BUENDIA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 E FLORENCE AVE SUITE B-2
HUNTINGTON PARK CA
90255-4755
US

IV. Provider business mailing address

2521 E FLORENCE AVE SUITE B-2
HUNTINGTON PARK CA
90255-4755
US

V. Phone/Fax

Practice location:
  • Phone: 323-582-4600
  • Fax: 323-582-4611
Mailing address:
  • Phone: 323-582-4600
  • Fax: 323-582-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number56579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: