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General NPI Number Information
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NPI Number | 1326934464
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Entity Type | Organization
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Legal Business Name | TRCALIFORNIA
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 416 W LAS TUNAS DR STE 107B
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City | SAN GABRIEL
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State | CA
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Zip | 91776-1236
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Country | US
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Telephone | 213-539-2166
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Fax |
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Provider Business Mailing Address
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Address Line | 416 W LAS TUNAS DR STE 107B
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City | SAN GABRIEL
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State | CA
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Zip | 91776-1236
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Country | US
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Telephone | 213-539-2166
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ETHAN CO
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Credential | DDS
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Telephone | 213-539-2166
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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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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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