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General NPI Number Information
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NPI Number | 1689266876
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Entity Type | Individual
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Provider Name | LIZETH YAMILETH CORREA DDS
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Gender | Female
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 825 S HILL ST APT 3204
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City | LOS ANGELES
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State | CA
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Zip | 90014-3299
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Country | US
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Telephone | 818-281-5012
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Fax |
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Provider Business Mailing Address
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Address Line | 825 S HILL ST APT 3204
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City | LOS ANGELES
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State | CA
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Zip | 90014-3299
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Country | US
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Telephone | 818-281-5012
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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 | 104773
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License Number State | CA
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