Healthcare Provider Details

I. General information

NPI: 1497282776
Provider Name (Legal Business Name): RALPH ERBIE MICHAEL PAEZ RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E ANAHEIM ST
WILMINGTON CA
90744-4516
US

IV. Provider business mailing address

2550 W MAIN ST
ALHAMBRA CA
91801-1694
US

V. Phone/Fax

Practice location:
  • Phone: 310-522-8700
  • Fax: 310-549-4546
Mailing address:
  • Phone: 626-457-6900
  • Fax: 626-457-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH30557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: