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General NPI Number Information
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NPI Number | 1497157085
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Entity Type | Organization
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Legal Business Name | MYLA RODRIGUEZ-SANTIAGO, DDS, INC.
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 1321 N VERMONT AVE SUITE 6
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City | LOS ANGELES
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State | CA
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Zip | 90027-6307
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Country | US
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Telephone | 323-662-8354
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Fax |
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Provider Business Mailing Address
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Address Line | 3323 ALABAMA ST
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City | GLENDALE
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State | CA
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Zip | 91214-1231
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MYLA RODRIGUEZ-SANTIAGO
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Credential |
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Telephone | 818-726-1597
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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 | 58558
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License Number State | CA
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