Healthcare Provider Details

I. General information

NPI: 1114872520
Provider Name (Legal Business Name): MICHELLE AVILA PIMENTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 DEEP VALLEY DR STE 345
ROLLING HILLS ESTATES CA
90274-7603
US

IV. Provider business mailing address

6366 GOTHAM ST
BELL GARDENS CA
90201-5622
US

V. Phone/Fax

Practice location:
  • Phone: 310-377-4551
  • Fax:
Mailing address:
  • Phone: 562-641-1784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number103945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: