Healthcare Provider Details

I. General information

NPI: 1942404397
Provider Name (Legal Business Name): CARLA CARMEN LOIACONO RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 WINFIELD BLVD SPC 153
SAN JOSE CA
95123-2422
US

IV. Provider business mailing address

5770 WINFIELD BLVD SPC 153
SAN JOSE CA
95123-2422
US

V. Phone/Fax

Practice location:
  • Phone: 408-608-7292
  • Fax:
Mailing address:
  • Phone: 408-608-7292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDHAP183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: