Healthcare Provider Details

I. General information

NPI: 1760696181
Provider Name (Legal Business Name): ROSSINA ESCOBAR YANES DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7365 CARNELIAN ST STE 236
R CUCAMONGA CA
91730
US

IV. Provider business mailing address

7365 CARNELIAN ST STE 236
R CUCAMONGA CA
91730
US

V. Phone/Fax

Practice location:
  • Phone: 909-466-4495
  • Fax: 909-466-4498
Mailing address:
  • Phone: 909-466-4495
  • Fax: 909-466-4498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number49308
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: