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General NPI Number Information
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NPI Number | 1447441597
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Entity Type | Organization
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Legal Business Name | GERTRUDE M. PECAOCO DENTAL CORP.
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 10/16/2018
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Provider Practice Location Address
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Address Line | 1925 W TEMPLE ST SUITE 214
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City | LOS ANGELES
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State | CA
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Zip | 90026-4970
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Country | US
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Telephone | 213-413-3910
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Fax | 213-413-4078
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Provider Business Mailing Address
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Address Line | 1925 W TEMPLE ST SUITE 214
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City | LOS ANGELES
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State | CA
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Zip | 90026-4970
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Country | US
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Telephone | 213-413-3910
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Fax | 213-413-4078
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. RICARDO ESPANOLA PECAOCO
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Credential |
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Telephone | 213-413-3910
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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 | 49425
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License Number State | CA
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