Healthcare Provider Details

I. General information

NPI: 1023722881
Provider Name (Legal Business Name): DR. MILAGROS A LOO GENERAL DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1194 S LORENA ST
LOS ANGELES CA
90023
US

IV. Provider business mailing address

1194 S. LORENA ST
LOS ANGELES CA
90023
US

V. Phone/Fax

Practice location:
  • Phone: 323-526-8189
  • Fax: 323-526-8314
Mailing address:
  • Phone: 323-526-8189
  • Fax: 323-526-8314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DORA H CASTILLO
Title or Position: MANAGER/ OR ADMINISTRATION
Credential:
Phone: 626-346-4411