Healthcare Provider Details

I. General information

NPI: 1710324629
Provider Name (Legal Business Name): MICHELE MARIA DARU R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 05/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12121 WILSHIRE BLVD SUITE 1111
LOS ANGELES CA
90025-1123
US

IV. Provider business mailing address

2175 S MALLUL DR APT 301
ANAHEIM CA
92802-4601
US

V. Phone/Fax

Practice location:
  • Phone: 310-820-9933
  • Fax:
Mailing address:
  • Phone: 714-916-1251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number25951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: