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General NPI Number Information
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NPI Number | 1053895565
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Entity Type | Organization
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Legal Business Name | LILI MIRTORABI D.D.S A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 2368 PICO BOULEVARD
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City | LOS ANGELES
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State | CA
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Zip | 90006
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Country | US
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Telephone | 844-347-5794
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Fax |
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Provider Business Mailing Address
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Address Line | 7722 SEVILLE AVE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-6316
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Country | US
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Telephone | 844-347-5794
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | GABRIELA VALDOVINOS
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Credential |
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Telephone | 323-228-9282
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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 |
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License Number State |
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