MEDICARE: MS. ALMA CARBONELL ROBLES DMD

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	1223G0001X	General Practice Dentistry	B36603	CA
2	122300000X	Dentist	36603	CA

General Provider Information

NPI Number	:	1508849241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALMA CARBONELL ROBLES DMD

Provider Business Mailing Address
First Line	:	4751 WILSHIRE BLVD STE 203C
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3860
Country	:	US
Telephone Number	:	213-383-5047
Fax Number	:	233-847-5051

Provider Business Practice Location Address
First Line	:	3875 WILSHIRE BLVD
Second Line	:	SUITE 1301
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3205
Country	:	US
Telephone Number	:	213-383-5047
Fax Number	:	213-383-3947

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	03/10/2020

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