Healthcare Provider Details

I. General information

NPI: 1982139143
Provider Name (Legal Business Name): JESSICA PARRA TERRAZAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 RIO RANCHO RD SUITE 120
POMONA CA
91766-7015
US

IV. Provider business mailing address

763 RIO RANCHO RD STE 120
POMONA CA
91766-7015
US

V. Phone/Fax

Practice location:
  • Phone: 909-766-1922
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberRDA87172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: