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General NPI Number Information
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NPI Number | 1568256329
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Entity Type | Organization
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Legal Business Name | CENTRO MEDICO AND DENTAL INC
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 2417 S. SAN PEDRO ST.
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City | LOS ANGELES
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State | CA
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Zip | 90011-1518
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Country | US
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Telephone | 213-749-3934
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Fax | 213-749-0994
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Provider Business Mailing Address
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Address Line | 417 S WETHERLY DR.
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3519
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Country | US
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Telephone | 310-383-9295
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Fax | 213-749-0994
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | MRS. VALERIA SOUCHUTSKI
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Credential |
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Telephone | 310-383-9295
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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 |
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License Number State |
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