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General NPI Number Information
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NPI Number | 1699120683
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Entity Type | Organization
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Legal Business Name | RAUL J. VALLEJO D. D. S., INC.
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 04/27/2016
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Provider Practice Location Address
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Address Line | 11301 ATLANTIC AVE
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City | LYNWOOD
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State | CA
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Zip | 90262-3007
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Country | US
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Telephone | 310-603-1383
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Fax | 310-603-1213
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Provider Business Mailing Address
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Address Line | 11301 ATLANTIC AVE
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City | LYNWOOD
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State | CA
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Zip | 90262-3007
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Country | US
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Telephone | 310-603-1383
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Fax | 310-603-1213
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Authorized Official
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Title or Position | DENTIST
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Name | DR. RAUL J VALLEJO
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Credential | DDS
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Telephone | 310-603-1318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 37376
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License Number State | CA
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