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General NPI Number Information
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NPI Number | 1245580778
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Entity Type | Organization
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Legal Business Name | NARVAEZ DDS, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 05/31/2019
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Provider Practice Location Address
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Address Line | 2055 LOMITA BLVD
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City | LOMITA
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State | CA
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Zip | 90717-1701
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Country | US
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Telephone | 310-530-3100
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Fax | 310-530-3103
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Provider Business Mailing Address
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Address Line | 1379 WEST PARK WESTERN DR. #517
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City | SAN PEDRO
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State | CA
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Zip | 90732-2300
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Country | US
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Telephone | 310-530-3100
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Fax | 310-530-3103
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Authorized Official
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Title or Position | PRESIDENT/CEO/DENTIST
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Name | MRS. ARELVIS ALEJANDRINA NARVAEZ-MOORE
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Credential | DDS
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Telephone | 310-530-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 56354
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License Number State | CA
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