Healthcare Provider Details

I. General information

NPI: 1376786442
Provider Name (Legal Business Name): CLAUDIA CLIMACO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2009
Last Update Date: 04/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W 6TH ST
LOS ANGELES CA
90017-1000
US

IV. Provider business mailing address

321 E FAIRVIEW AVE APTO #104
GLENDALE CA
91207-1968
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-5151
  • Fax:
Mailing address:
  • Phone: 818-546-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number64000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: