Healthcare Provider Details

I. General information

NPI: 1134355969
Provider Name (Legal Business Name): MA DEL CONSUELO D'ALESSANDRO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 WHITTIER BLVD
LOS ANGELES CA
90023-2440
US

IV. Provider business mailing address

1600 SAN FERNANDO RD
SAN FERNANDO CA
91340-3115
US

V. Phone/Fax

Practice location:
  • Phone: 323-265-1998
  • Fax:
Mailing address:
  • Phone: 818-365-8086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: