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General NPI Number Information
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NPI Number | 1174970123
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Entity Type | Organization
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Legal Business Name | BELENDA VILLARUEL ABANILLA DENTAL CORPORATION
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Dates
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Enumeration Date | 05/19/2016
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Last Update Date | 05/19/2016
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Provider Practice Location Address
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Address Line | 3017 E FLORENCE AVE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-5827
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Country | US
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Telephone | 323-584-1171
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Fax |
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Provider Business Mailing Address
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Address Line | 3017 E FLORENCE AVE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-5827
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Country | US
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Telephone | 323-584-1171
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BELENDA ABANILLA
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Credential |
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Telephone | 323-584-1171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 39223
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License Number State | CA
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