Healthcare Provider Details

I. General information

NPI: 1023255544
Provider Name (Legal Business Name): MISS MARIA ELENA OSEGUERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W. 6TH STREET WEST COAST DENTAL 6TH STREET
LOS ANGELES CA
90017
US

IV. Provider business mailing address

6725 MALABAR STREET APT. #A
HUNTINGTON PARK CA
90255
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-5151
  • Fax: 213-413-7171
Mailing address:
  • Phone: 323-588-7802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: