MEDICARE: DR. CORINTHIA MORALES ANDAL DDS

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	122300000X	Dentist	53574	CA

General Provider Information

NPI Number	:	1619114428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORINTHIA MORALES ANDAL DDS

Provider Business Mailing Address
First Line	:	150 S GLENDORA AVE
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-3038
Country	:	US
Telephone Number	:	626-919-2322
Fax Number	:	626-919-2333

Provider Business Practice Location Address
First Line	:	150 S GLENDORA AVE
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-3038
Country	:	US
Telephone Number	:	626-919-2322
Fax Number	:	626-919-2333

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

Provider Enumeration Date	:	01/15/2009
Last Update Date	:	08/08/2013

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