MEDICARE: MRS. ARA TOBAR RDH

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	124Q00000X	Dental Hygienist	23818	CA

General Provider Information

NPI Number	:	1861828279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ARA TOBAR RDH

Provider Business Mailing Address
First Line	:	PO BOX 575
Second Line	:	595 CEDAR LN
City	:	TWIN PEAKS
State	:	CA
Zip	:	92391-0575
Country	:	US
Telephone Number	:	626-485-4641
Fax Number	:

Provider Business Practice Location Address
First Line	:	29101 HOSPITAL RD
Second Line	:
City	:	LAKE ARROWHEAD
State	:	CA
Zip	:	92352-9706
Country	:	US
Telephone Number	:	909-336-9715
Fax Number	:

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

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	09/17/2013

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