MEDICARE: THERESE JAMIE PARADO D.D.S.

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	1223P0221X	Pediatric Dentistry	60166	CA

General Provider Information

NPI Number	:	1609005602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESE JAMIE PARADO D.D.S.

Provider Business Mailing Address
First Line	:	14722 HAWTHORNE BLVD
Second Line	:	SUITE A
City	:	LAWNDALE
State	:	CA
Zip	:	90260-1505
Country	:	US
Telephone Number	:	310-973-5437
Fax Number	:

Provider Business Practice Location Address
First Line	:	14722 HAWTHORNE BLVD
Second Line	:	SUITE A
City	:	LAWNDALE
State	:	CA
Zip	:	90260-1505
Country	:	US
Telephone Number	:	310-973-5437
Fax Number	:

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

Provider Enumeration Date	:	07/10/2009
Last Update Date	:	05/06/2013

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