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General NPI Number Information
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NPI Number | 1013194117
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Entity Type | Organization
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Legal Business Name | CORAZON C RABONZA DDS INC
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 01/31/2008
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Provider Practice Location Address
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Address Line | 14622 VENTURA BLVD SUITE 202
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City | SHERMAN OAKS
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State | CA
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Zip | 91403
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Country | US
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Telephone | 818-788-3168
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Fax | 818-788-0610
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Provider Business Mailing Address
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Address Line | 14622 VENTURA BLVD SUITE 202
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City | SHERMAN OAKS
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State | CA
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Zip | 91403
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Country | US
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Telephone | 818-788-3168
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Fax | 818-788-0610
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. MARIA CORAZON CARLOS RABONZA
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Credential | DDS
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Telephone | 818-788-3168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 45520
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License Number State | CA
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