Healthcare Provider Details

I. General information

NPI: 1811593544
Provider Name (Legal Business Name): JANETTE GARCIA CARDONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 12/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12121 WILSHIRE BLVD., STEVE.1111
LOS ANGELES CA
90025
US

IV. Provider business mailing address

1016 S BONNIE BEACH PL APT D
LOS ANGELES CA
90023-2548
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number33332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: