Healthcare Provider Details

I. General information

NPI: 1891732798
Provider Name (Legal Business Name): AZITA RAYET D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3242 W 8TH ST
LOS ANGELES CA
90005-2176
US

IV. Provider business mailing address

1300 N VERMONT AVE SUITE 1002
LOS ANGELES CA
90027-6005
US

V. Phone/Fax

Practice location:
  • Phone: 213-368-9779
  • Fax: 213-368-9793
Mailing address:
  • Phone: 323-953-7341
  • Fax: 323-953-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number52459
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: