Healthcare Provider Details

I. General information

NPI: 1134191646
Provider Name (Legal Business Name): FERMINA VILLAREAL BEBING DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 MELROSE AVE
LOS ANGELES CA
90029
US

IV. Provider business mailing address

4615 MELROSE AVE
LOS ANGELES CA
90029
US

V. Phone/Fax

Practice location:
  • Phone: 323-667-1750
  • Fax:
Mailing address:
  • Phone: 323-667-1750
  • Fax: 323-667-1750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number50728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: