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General NPI Number Information
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NPI Number | 1447670617
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Entity Type | Organization
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Legal Business Name | REYNALDO D ECLAVEA, DMD, INC
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Dates
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Enumeration Date | 04/25/2014
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Last Update Date | 04/25/2014
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Provider Practice Location Address
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Address Line | 3508 W SUNSET BLVD # B
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City | LOS ANGELES
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State | CA
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Zip | 90026-2106
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Country | US
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Telephone | 323-660-3876
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Fax | 323-660-0476
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Provider Business Mailing Address
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Address Line | 3508 W SUNSET BLVD # B
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City | LOS ANGELES
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State | CA
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Zip | 90026-2106
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Country | US
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Telephone | 323-660-3876
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Fax | 323-660-0476
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. REYNALDO DIMASIN ECLAVEA
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Credential | DMD
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Telephone | 323-660-3876
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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 | 34952
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License Number State | CA
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