Healthcare Provider Details

I. General information

NPI: 1073935128
Provider Name (Legal Business Name): MICAEL HILARIO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 W CARSON ST STE A
TORRANCE CA
90501-3189
US

IV. Provider business mailing address

2275 W CARSON ST STE A
TORRANCE CA
90501-3189
US

V. Phone/Fax

Practice location:
  • Phone: 310-782-6155
  • Fax:
Mailing address:
  • Phone: 310-782-6155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number056889-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDDS101038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: