Healthcare Provider Details

I. General information

NPI: 1720570468
Provider Name (Legal Business Name): FRANCISCA LOPEZ RDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13428 BENFIELD AVE
NORWALK CA
90650-3617
US

IV. Provider business mailing address

11635 SOUTH ST
ARTESIA CA
90701-6628
US

V. Phone/Fax

Practice location:
  • Phone: 562-868-4387
  • Fax:
Mailing address:
  • Phone: 562-921-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number48196
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: