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General NPI Number Information
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NPI Number | 1306454327
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Entity Type | Individual
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Provider Name | LUZ EDITH ORTIZ GOMEZ
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Gender | Female
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Dates
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Enumeration Date | 07/15/2020
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 14525 LAKEWOOD BLVD STE A
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City | PARAMOUNT
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State | CA
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Zip | 90723-3638
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Country | US
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Telephone | 562-205-8091
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Fax |
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Provider Business Mailing Address
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Address Line | 14101 PARAMOUNT BLVD
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City | PARAMOUNT
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State | CA
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Zip | 90723-2607
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Country | US
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Telephone |
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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 | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | RDA94499
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License Number State | CA
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