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General NPI Number Information
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NPI Number | 1821130477
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Entity Type | Organization
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Legal Business Name | MONCADA DENTAL CORPORATION
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 1321 N VERMONT AVE SUITE B
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City | LOS ANGELES
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State | CA
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Zip | 90027
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Country | US
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Telephone | 323-663-7897
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Fax | 323-663-7803
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Provider Business Mailing Address
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Address Line | 1321 N VERMONT AVE SUITE B
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City | LOS ANGELES
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State | CA
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Zip | 90027
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Country | US
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Telephone | 323-663-7897
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Fax | 323-663-7803
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Authorized Official
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Title or Position | DENTIST
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Name | MARCELO G MONCADA
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Credential |
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Telephone | 323-663-7897
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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 | 43643
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License Number State | CA
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