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NPI Code Detail

MEDICARE: DR. CELIA PONCE OCTOMAN D.D.S.

MEDICARE: DR. CELIA PONCE OCTOMAN 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
11223G0001XGeneral Practice Dentistry30490CA

General Provider Information

NPI Number : 1790963890
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CELIA PONCE OCTOMAN D.D.S.
Provider Business Mailing Address
First Line : 2023 BEVERLY BLVD.
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057
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 :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2008
Last Update Date : 01/31/2008

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