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NPI Code Detail

MEDICARE: CELIA P. OCTOMAN, DMD, INC.

MEDICARE: CELIA P. OCTOMAN, DMD, INC.
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
11223G0001XGeneral Practice Dentistry30490CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1D30490OTHERCADENTICAL

General Provider Information

NPI Number : 1750431516
Entity Type Code : Organization
Provider Name (Legal Business Name) : CELIA P. OCTOMAN, DMD, INC.
Provider Business Mailing Address
First Line : 2023 BEVERLY BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057-2417
Country : US
Telephone Number : 213-353-9930
Fax Number :
Provider Business Practice Location Address
First Line : 2023 BEVERLY BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057-2417
Country : US
Telephone Number : 213-353-9930
Fax Number : 213-353-0990
Authorized Official
Title or Position : PRESIDENT
Name : DR. CELIA PONCE OCTOMAN
Credential : DDS
Telephone Number : 213-353-9930
Provider Enumeration Date : 01/11/2007
Last Update Date : 02/08/2008

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