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General NPI Number Information
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NPI Number | 1194122358
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Entity Type | Organization
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Legal Business Name | LUDIVINA L PAGATPATAN,D.D.S.,INC.
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 3949 ARTESIA BLVD
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City | TORRANCE
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State | CA
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Zip | 90504-3210
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Country | US
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Telephone | 310-303-3988
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Fax | 310-303-3919
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Provider Business Mailing Address
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Address Line | 211 PISMO DR
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City | CARSON
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State | CA
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Zip | 90745-4740
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Country | US
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Telephone | 310-952-0895
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUDIVINA LUIS PAGATPATAN
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Credential | DDS
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Telephone | 310-303-3988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 48162
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License Number State | CA
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