Healthcare Provider Details

I. General information

NPI: 1508002668
Provider Name (Legal Business Name): MIGUEL ANGEL CANTERO RDA EF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2008
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 SEPULVEDA BLVD SUITE #1
TORRANCE CA
90501-5645
US

IV. Provider business mailing address

1730 SEPULVEDA BLVD SUITE #1
TORRANCE CA
90501-5645
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 Number44265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: