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General NPI Number Information
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NPI Number | 1801075676
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Entity Type | Organization
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Legal Business Name | MAXIMA ERNACIO , DMD, INC.
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 2105 BEVERLY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90057-2216
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Country | US
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Telephone | 213-483-8756
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Fax |
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Provider Business Mailing Address
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Address Line | 2105 BEVERLY BLVD. SUITE 123
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City | LOS ANGELES
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State | CA
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Zip | 90057-2259
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Country | US
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Telephone | 213-483-8756
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Fax | 213-483-8755
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAXIMA J ERNACIO
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Credential | DMD
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Telephone | 213-483-8756
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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 | 44167
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License Number State | CA
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