Edgar De la Rocha
Individual provider Active NPI Dental Assistant · Cudahy, CA
NPI 1114164704 · NPPES record last updated Jan 19, 2009
Key facts
- NPI
- 1114164704
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Assistant 126800000X
- Practice address
- 4826 Elizabeth St
Cudahy, CA 90201-5206 - Phone
- (323) 560-3659
- NPI assigned
- Jan 19, 2009
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Assistant | 126800000X | CA | Yes |
Addresses
Primary practice location
4826 Elizabeth St
Cudahy, CA 90201-5206
Mailing address
4826 Elizabeth St
Cudahy, CA 90201-5206
Phone (323) 560-3659
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All providers in Cudahy, CA · Dental Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 19, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.