Healthcare Provider Details

I. General information

NPI: 1104217199
Provider Name (Legal Business Name): MARIA ELENA TAPIA DDS A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

881 ALMA REAL DR APT 205A
PACIFIC PALISADES CA
90272-5048
US

IV. Provider business mailing address

881 ALMA REAL DR APT 205A
PACIFIC PALISADES CA
90272-5048
US

V. Phone/Fax

Practice location:
  • Phone: 310-454-0912
  • Fax: 424-272-9860
Mailing address:
  • Phone: 310-454-0912
  • Fax: 424-272-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number49226
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number51154
License Number StateCA

VIII. Authorized Official

Name: MRS. MARIA ELENA TAPIA
Title or Position: OWNER
Credential: DDS
Phone: 310-454-0912