Healthcare Provider Details

I. General information

NPI: 1073729760
Provider Name (Legal Business Name): PAULINA JO AUGUSTA ATTEBERY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S ALVARADO ST
LOS ANGELES CA
90057-2238
US

IV. Provider business mailing address

25 SHORT WAY ST
SOUTH PASADENA CA
91030-4050
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-9660
  • Fax:
Mailing address:
  • Phone: 323-259-9717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number11949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: