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General NPI Number Information
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NPI Number | 1750077301
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Entity Type | Organization
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Legal Business Name | CRL3 LLC
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Dates
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Enumeration Date | 04/17/2023
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 3860 CRENSHAW BLVD STE 229
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City | LOS ANGELES
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State | CA
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Zip | 90008-1824
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Country | US
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Telephone | 310-505-2509
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Fax |
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Provider Business Mailing Address
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Address Line | 8605 SANTA MONICA BLVD # 275065
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City | LOS ANGELES
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State | CA
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Zip | 90069-4109
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Country | US
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Telephone | 310-505-2509
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARLA BELGARDE-DURU
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Credential | DDS
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Telephone | 310-505-2509
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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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