Healthcare Provider Details

I. General information

NPI: 1083452627
Provider Name (Legal Business Name): INOCENTE DAVID ARIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 WHITTIER BLVD
LOS ANGELES CA
90023-2527
US

IV. Provider business mailing address

230 1/2 S SOTO ST
LOS ANGELES CA
90033-4034
US

V. Phone/Fax

Practice location:
  • Phone: 323-582-4474
  • Fax: 323-582-3101
Mailing address:
  • Phone: 323-695-0191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number31567
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: