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General NPI Number Information
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NPI Number | 1174037873
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Entity Type | Organization
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Legal Business Name | DI ALPAN PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/17/2017
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Last Update Date | 11/17/2017
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Provider Practice Location Address
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Address Line | 11633 HAWTHORNE BLVD #500
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City | HAWTHORNE
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State | CA
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Zip | 90250-9025
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Country | US
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Telephone | 310-644-4412
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Fax | 310-644-7355
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Provider Business Mailing Address
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Address Line | 11633 HAWTHORNE BLVD STE 500
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City | HAWTHORNE
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State | CA
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Zip | 90250-2326
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Country | US
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Telephone | 310-644-4412
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ROSA SALAZAR
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Credential |
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Telephone | 310-644-4412
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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 | 43750
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License Number State | CA
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