Healthcare Provider Details

I. General information

NPI: 1477878148
Provider Name (Legal Business Name): KARLA VANESA CEHUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423N. MEYLER ST.
SAN PEDRO CA
90731
US

IV. Provider business mailing address

423 N. MEYLER
SAN PEDRO CA
90731
US

V. Phone/Fax

Practice location:
  • Phone: 310-325-8888
  • Fax: 310-325-3024
Mailing address:
  • Phone: 310-325-8888
  • Fax: 310-325-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: