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General NPI Number Information
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NPI Number | 1811031057
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Entity Type | Individual
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Provider Name | MARY ROSE BICIERRO MANZANA D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 24307 ASTOR RACING CT
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City | VALENCIA
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State | CA
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Zip | 91354-4918
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Country | US
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Telephone | 661-714-1361
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Fax | 661-294-5018
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Provider Business Mailing Address
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Address Line | 24307 ASTOR RACING CT
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City | VALENCIA
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State | CA
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Zip | 91354-4918
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Country | US
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Telephone | 661-714-1361
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Fax | 661-294-5018
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 45917
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License Number State | CA
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