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General NPI Number Information
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NPI Number | 1053707265
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Entity Type | Organization
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Legal Business Name | DR. PATRICIA PANUCCI
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 1730 MANHATTAN BEACH BLVD SUITE B
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-6220
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Country | US
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Telephone | 310-379-0006
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Fax |
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Provider Business Mailing Address
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Address Line | 1730 MANHATTAN BEACH BLVD SUITE B
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-6220
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Country | US
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Telephone | 310-379-0006
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICIA PANUCCI
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Credential | D.M.D., M.S.
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Telephone | 310-379-0006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 51124
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License Number State | CA
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