=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275708216
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVELYN V. CATUIRA , D.D.S. INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2008
-----------------------------------------------------
Last Update Date | 04/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 966 N DIAMOND BAR BLVD
-----------------------------------------------------
City | DIAMOND BAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91765-1040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-396-5111
-----------------------------------------------------
Fax | 909-396-5115
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 966 N DIAMOND BAR BLVD
-----------------------------------------------------
City | DIAMOND BAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91765-1040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-396-5111
-----------------------------------------------------
Fax | 909-396-5115
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / DENTIST
-----------------------------------------------------
Name | DR. EVELYN V CATUIRA
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 909-396-5111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 47237
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------