Healthcare Provider Details

I. General information

NPI: 1417447681
Provider Name (Legal Business Name): MARY LOU JUANATAS MURTHA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WEST CARSON STREET BOX #25
TORRANCE CA
90509
US

IV. Provider business mailing address

1000 WEST CARSON STREET BOX #25
TORRANCE CA
90509
US

V. Phone/Fax

Practice location:
  • Phone: 424-338-2710
  • Fax: 310-533-2210
Mailing address:
  • Phone: 424-306-4263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number106096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: