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General NPI Number Information
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NPI Number | 1730733973
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Entity Type | Individual
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Provider Name | GARY LABORADA
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Gender | Male
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 12/07/2025
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Provider Practice Location Address
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Address Line | 1532 SAN BERNARDINO AVE
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City | POMONA
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State | CA
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Zip | 91767-3559
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Country | US
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Telephone | 760-245-0151
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Fax |
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Provider Business Mailing Address
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Address Line | 13156 FLAGSTAFF DR
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-9262
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Country | US
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Telephone | 909-471-3764
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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 | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | GA2241
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 104124
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License Number State | CA
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