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General NPI Number Information
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NPI Number | 1205181179
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Entity Type | Individual
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Provider Name | MICHAEL E IGNACIO D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 07/17/2012
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Provider Practice Location Address
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Address Line | 1916 W. COLORADO
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City | LOS ANGELES
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State | CA
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Zip | 90041
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Country | US
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Telephone | 323-340-8014
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Fax | 323-340-8932
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Provider Business Mailing Address
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Address Line | 1009 E. MOUNTAIN STREET
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City | GLENDALE
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State | CA
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Zip | 91207
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Country | US
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Telephone | 818-636-4057
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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 | 61450
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License Number State | CA
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