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General NPI Number Information
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NPI Number | 1447504212
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Entity Type | Individual
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Provider Name | LALAINE CALINOG MABANSAG DDS
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Gender | Female
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Dates
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Enumeration Date | 11/01/2012
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 9063 VAN NUYS BLVD
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City | PANORAMA CITY
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State | CA
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Zip | 91402-1812
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Country | US
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Telephone | 818-830-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 5120 CAHUENGA BLVD
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91601-4001
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Country | US
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Telephone | 818-427-3627
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 45143
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License Number State | CA
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