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General NPI Number Information
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NPI Number | 1396934808
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Entity Type | Organization
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Legal Business Name | ANA M. GAJARDO, DDS, INC.
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Dates
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Enumeration Date | 10/20/2007
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Last Update Date | 10/20/2007
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Provider Practice Location Address
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Address Line | 5415 WHITTIER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-4101
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Country | US
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Telephone | 323-722-4371
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Fax | 323-722-4703
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Provider Business Mailing Address
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Address Line | 5415 WHITTIER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-4101
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Country | US
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Telephone | 323-722-4371
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Fax | 323-722-4703
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANA MARIA GAJARDO
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Credential | DDS
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Telephone | 323-722-4371
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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 | 31263
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License Number State | CA
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