Healthcare Provider Details

I. General information

NPI: 1407308166
Provider Name (Legal Business Name): BRITTNEY PENAMON RDHAP CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 STOCKER ST #23
VIEW PARK CA
90008-5122
US

IV. Provider business mailing address

4859 W SLAUSON AVE STE 134
LOS ANGELES CA
90056-1290
US

V. Phone/Fax

Practice location:
  • Phone: 323-998-3001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number589
License Number StateCA

VIII. Authorized Official

Name: BRITTNEY PENAMON
Title or Position: OWNER
Credential:
Phone: 323-998-3001