Healthcare Provider Details

I. General information

NPI: 1871448274
Provider Name (Legal Business Name): BRENDA JANETTE DIAZ OJEDA
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

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

V. Phone/Fax

Practice location:
  • Phone: 310-377-4551
  • Fax: 310-541-6042
Mailing address:
  • Phone: 310-377-4551
  • Fax: 310-541-6042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number82505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: