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General NPI Number Information
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NPI Number | 1366960783
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Entity Type | Organization
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Legal Business Name | MARIA ELENA NEWCOMER DDS INC
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 09/06/2017
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Provider Practice Location Address
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Address Line | 847 W. 9TH ST.
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City | SAN PEDRO
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State | CA
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Zip | 90731
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Country | US
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Telephone | 510-831-0804
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Fax | 310-831-5731
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Provider Business Mailing Address
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Address Line | 847 W. 9TH ST.
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City | SAN PEDRO
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State | CA
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Zip | 90731
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Country | US
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Telephone | 310-831-0804
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Fax | 310-831-5731
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | GABRIELA CORONADO
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Credential |
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Telephone | 310-515-5505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 44959
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License Number State | CA
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