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General NPI Number Information
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NPI Number | 1770929747
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Entity Type | Organization
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Legal Business Name | MARISSA FAELDAN-SUAREZ, INC
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Dates
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Enumeration Date | 05/17/2013
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Last Update Date | 05/17/2013
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Provider Practice Location Address
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Address Line | 5432 SEPULVEDA BLVD SUITE B
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City | CULVER CITY
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State | CA
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Zip | 90230-5512
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Country | US
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Telephone | 626-379-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 5432 SEPULVEDA BLVD SUITE B
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City | CULVER CITY
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State | CA
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Zip | 90230-5512
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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 | PEDIATRIC DENTIST
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Name | DR. MARISSA FAELDAN-SUAREZ
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Credential |
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Telephone | 626-379-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 58944
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License Number State | CA
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