Healthcare Provider Details

I. General information

NPI: 1114843349
Provider Name (Legal Business Name): PRECIOUS NWABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 ATLANTIC AVE
LONG BEACH CA
90813-2018
US

IV. Provider business mailing address

22206 GRACE AVE
CARSON CA
90745-3228
US

V. Phone/Fax

Practice location:
  • Phone: 562-591-4028
  • Fax:
Mailing address:
  • Phone: 323-518-9963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: