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General NPI Number Information
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NPI Number | 1366094112
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Entity Type | Individual
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Provider Name | ALMA EVELIA VELASQUEZ RDA
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Gender | Female
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Dates
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Enumeration Date | 07/11/2019
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Last Update Date | 07/11/2019
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Provider Practice Location Address
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Address Line | 4000 LA RICA AVE STE D
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City | BALDWIN PARK
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State | CA
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Zip | 91706-3163
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Country | US
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Telephone | 626-430-9171
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Fax |
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Provider Business Mailing Address
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Address Line | 3755 LA MADERA AVE
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City | EL MONTE
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State | CA
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Zip | 91732-2321
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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 | RDA56826
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License Number State | CA
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