Healthcare Provider Details

I. General information

NPI: 1356206767
Provider Name (Legal Business Name): JOSE TRINIDAD URIBE RDHAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 CAHUENGA BLVD W STE 300
LOS ANGELES CA
90068-1342
US

IV. Provider business mailing address

3908 W 110TH ST
INGLEWOOD CA
90303-2128
US

V. Phone/Fax

Practice location:
  • Phone: 818-980-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: