Lidya Soraya Acevedo
Individual provider Active NPI General Practice Dentistry · Inglewood, CA
NPI 1881873552 · NPPES record last updated Oct 30, 2007
Key facts
- NPI
- 1881873552
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 55423 (CA)
- Practice address
- 11976 Aviation Blvd
Inglewood, CA 90304-1001 - Phone
- (310) 643-6221
- NPI assigned
- Oct 30, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200114000113 | CA | Practitioner - Oral Surgery | 5193150522 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Javid Brothers | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 55423 | CA | Yes |
Addresses
Primary practice location
11976 Aviation Blvd
Inglewood, CA 90304-1001
Mailing address
257 S Reeves Dr
PH
Beverly Hills, CA 90212-4046
Phone (786) 290-3652
Other providers in Inglewood, CA
- Brittani Ables
- George Abraham
- Pamela Abraham
- Samira Abrishami
- Ace Medical Transport
- Gloria Rubio Acosta
- Acostal Express LLC
- Action A1 Medical Supplies
- April Chantay Adams
- Kimberly Adams
All providers in Inglewood, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.