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General NPI Number Information
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NPI Number | 1427120815
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Entity Type | Organization
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Legal Business Name | CZARINNE A FETALINO DMD INC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1220 S DIAMOND BAR BLVD SUITE G
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City | DIAMOND BAR
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State | CA
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Zip | 91765
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Country | US
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Telephone | 909-396-7207
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Fax | 909-396-7242
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Provider Business Mailing Address
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Address Line | 1220 S DIAMOND BAR BLVD SUITE G
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City | DIAMOND BAR
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State | CA
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Zip | 91765
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Country | US
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Telephone | 909-396-7207
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Fax | 909-396-7242
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Authorized Official
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Title or Position | OWNER
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Name | DR. CZARINNE ANO FETALINO
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Credential | DMD
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Telephone | 909-396-7207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 47889
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License Number State | CA
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