Healthcare Provider Details

I. General information

NPI: 1700229903
Provider Name (Legal Business Name): RAMI ETESSAMI DDS. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD SUITE 908
LOS ANGELES CA
90069-3701
US

IV. Provider business mailing address

9201 W SUNSET BLVD SUITE 908
LOS ANGELES CA
90069-3701
US

V. Phone/Fax

Practice location:
  • Phone: 310-550-0506
  • Fax:
Mailing address:
  • Phone: 310-550-0506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number35209
License Number StateCA

VIII. Authorized Official

Name: DR. RAMI ETESSAMI
Title or Position: OWNER
Credential:
Phone: 310-550-0506