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General NPI Number Information
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NPI Number | 1396474813
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Entity Type | Individual
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Provider Name | BIANCA PATRICIA NINO-LANATHOUA
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Gender | Female
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 16944 S HIGHLAND AVE STE 400
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City | FONTANA
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State | CA
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Zip | 92336-3467
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Country | US
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Telephone | 909-275-7179
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Fax |
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Provider Business Mailing Address
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Address Line | 841 S TERRI ANN DR
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City | WEST COVINA
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State | CA
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Zip | 91791-3238
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Country | US
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Telephone | 909-614-5909
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 109404
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License Number State | CA
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