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General NPI Number Information
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NPI Number | 1558607168
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Entity Type | Individual
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Provider Name | BLANCA MICHELLE CARACHURE D.A
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Gender | Female
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Dates
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Enumeration Date | 12/31/2012
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Last Update Date | 12/31/2012
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Provider Practice Location Address
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Address Line | 5807 N FIGUEROA ST
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City | HIGHLAND PARK
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State | CA
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Zip | 90042-4227
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Country | US
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Telephone | 323-982-0999
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Fax |
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Provider Business Mailing Address
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Address Line | 300 W AVENUE 37 APT 112
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City | LOS ANGELES
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State | CA
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Zip | 90065-2552
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Country | US
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Telephone | 323-216-5694
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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 | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | 4481410
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License Number State | CA
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