MEDICARE: BETZABEL IRIS ARHELY TOVAR QUINONEZ R.D.A

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	126800000X	Dental Assistant	70550	CA

General Provider Information

NPI Number	:	1801038039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETZABEL IRIS ARHELY TOVAR QUINONEZ R.D.A

Provider Business Mailing Address
First Line	:	6541 SAN VINCENTE ST
Second Line	:
City	:	PARAMOUNT
State	:	CA
Zip	:	90723-2938
Country	:	US
Telephone Number	:	562-529-3576
Fax Number	:

Provider Business Practice Location Address
First Line	:	6541 SAN VINCENTE ST
Second Line	:
City	:	PARAMOUNT
State	:	CA
Zip	:	90723-2938
Country	:	US
Telephone Number	:	562-529-3576
Fax Number	:

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

Provider Enumeration Date	:	04/02/2009
Last Update Date	:	04/02/2009

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