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General NPI Number Information
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NPI Number | 1336782796
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Entity Type | Individual
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Provider Name | ANGELICA LOPEZ RDA
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Gender | Female
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Dates
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Enumeration Date | 10/17/2019
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Last Update Date | 10/17/2019
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Provider Practice Location Address
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Address Line | 2604 S VERMONT AVE STE F
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City | LOS ANGELES
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State | CA
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Zip | 90007-2298
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Country | US
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Telephone | 323-212-5495
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Fax |
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Provider Business Mailing Address
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Address Line | 1412 E 60TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90001-1217
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Country | US
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Telephone | 323-627-9150
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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 | 92440
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License Number State | CA
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