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General NPI Number Information
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NPI Number | 1134596083
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Entity Type | Individual
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Provider Name | MYOLI HERRERO LANDIG D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 08/26/2015
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 1241 GRAND AVE STE G
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4447
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Country | US
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Telephone | 909-396-5161
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Fax | 909-396-5165
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Provider Business Mailing Address
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Address Line | 5382 EDGEWOOD DR
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City | LA VERNE
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State | CA
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Zip | 91750-1715
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Country | US
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Telephone | 951-255-4925
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 64964
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License Number State | CA
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