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General NPI Number Information
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NPI Number | 1265906705
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Entity Type | Organization
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Legal Business Name | MIRIAM BUENAVENTURA DENTAL CORPORATION
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Dates
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Enumeration Date | 01/17/2019
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 5031 EAGLE ROCK BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90041-1923
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Country | US
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Telephone | 323-256-6428
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Fax | 323-256-8439
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Provider Business Mailing Address
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Address Line | 5031 EAGLE ROCK BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90041-1923
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Country | US
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Telephone | 323-256-6428
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Fax |
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Authorized Official
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Title or Position | OPERATIONS AND FINANCE MANAGER
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Name | ANGELO LINSANGAN
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Credential |
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Telephone | 323-256-6428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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