Healthcare Provider Details

I. General information

NPI: 1851832703
Provider Name (Legal Business Name): ANA PAOLA MENESES ZAMBRANO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2017
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11905 S CENTRAL AVE STE 203
LOS ANGELES CA
90059-2897
US

IV. Provider business mailing address

350 S HARVARD BLVD APT 106
LOS ANGELES CA
90020-5500
US

V. Phone/Fax

Practice location:
  • Phone: 323-564-7504
  • Fax:
Mailing address:
  • Phone: 786-303-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number103407
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: