MEDICARE: MRS. BEATRIZ ADRIANA ESPINOZA RDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	126800000X	Dental Assistant	65301	CA

General Provider Information

NPI Number	:	1225261944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BEATRIZ ADRIANA ESPINOZA RDA

Provider Business Mailing Address
First Line	:	920 S BONNIE BEACH PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-2514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 S BONNIE BEACH PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-2514
Country	:	US
Telephone Number	:	310-820-9933
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2009
Last Update Date	:	08/27/2009

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