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General NPI Number Information
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NPI Number | 1568168698
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Entity Type | Individual
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Provider Name | LENY JOVANA BROTHERTON DDS
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Gender | Female
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 8627 ATLANTIC AVE
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City | SOUTH GATE
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State | CA
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Zip | 90280-3501
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Country | US
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Telephone | 888-226-7479
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Fax | 323-562-3903
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Provider Business Mailing Address
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Address Line | 1448 ELEMENTS WAY UNIT 1448
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City | IRVINE
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State | CA
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Zip | 92612-6558
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Country | US
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Telephone | 305-496-6178
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 108508
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License Number State | CA
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