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General NPI Number Information
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NPI Number | 1376914986
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Entity Type | Organization
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Legal Business Name | ESPERANZA DENTAL INC
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 4201 SLAUSON AVE
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City | MAYWOOD
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State | CA
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Zip | 90270-2835
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Country | US
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Telephone | 323-771-1885
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Fax |
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Provider Business Mailing Address
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Address Line | 4201 SLAUSON AVE
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City | MAYWOOD
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State | CA
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Zip | 90270-2835
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Country | US
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Telephone | 323-771-1885
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | DR. ANA Y PALACIOS
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Credential |
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Telephone | 323-771-1885
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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 | 55938
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License Number State | CA
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