MEDICARE: NORMA A BACA 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	1223G0001X	General Practice Dentistry	27866	CA

General Provider Information

NPI Number	:	1720127962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORMA A BACA D.D.S.

Provider Business Mailing Address
First Line	:	1919 BEVERLY BLVD STE A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2401
Country	:	US
Telephone Number	:	213-484-2165
Fax Number	:	213-484-0162

Provider Business Practice Location Address
First Line	:	1919 BEVERLY BLVD STE A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2401
Country	:	US
Telephone Number	:	213-484-2165
Fax Number	:	213-484-0162

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	12/16/2013

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