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General NPI Number Information
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NPI Number | 1710195243
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Entity Type | Organization
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Legal Business Name | MARITESS TINOCO, DDS AND DIANA SIMBOL, DDS, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1403 W. LOMITA BLVD. SUITE 306
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City | HARBOR CITY
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State | CA
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Zip | 90710
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Country | US
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Telephone | 310-530-1175
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Fax |
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Provider Business Mailing Address
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Address Line | 1403 W. LOMITA BLVD. SUITE 306
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City | HARBOR CITY
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State | CA
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Zip | 90710
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. DIANA SIMBOL
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Credential | DDS
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Telephone | 310-530-1175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 46969
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License Number State | CA
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