Healthcare Provider Details

I. General information

NPI: 1205175866
Provider Name (Legal Business Name): ESTELITA GARCIA TORRIS, DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29701 S WESTERN AVE SUITE 102
RANCHO PALOS VERDES CA
90275-1359
US

IV. Provider business mailing address

29701 S WESTERN AVE SUITE 102
RANCHO PALOS VERDES CA
90275-1359
US

V. Phone/Fax

Practice location:
  • Phone: 310-221-0300
  • Fax: 310-221-0580
Mailing address:
  • Phone: 310-221-0300
  • Fax: 310-221-0580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number39218
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number39218
License Number StateCA

VIII. Authorized Official

Name: DR. ESTILTA GARCIA TORRES
Title or Position: DR./OWNER
Credential: DMD
Phone: 310-221-0300