Sayra Maria Antolin

Individual provider Active NPI Dental Assistant · Artesia, CA

NPI 1891301909 · NPPES record last updated Sep 23, 2020

Key facts

NPI
1891301909
Entity type
Individual (NPI type 1)
Primary specialty
Dental Assistant 126800000X
License
93134 (CA)
Practice address
11635 South St
Artesia, CA 90701-6628
Phone
(562) 924-4401
NPI assigned
Sep 23, 2020
Sex
Female
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

State licenses

LicenseStateTypeSpecialty
93134CAMDDental Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Assistant 126800000X 93134 CA Yes

Addresses

Primary practice location

11635 South St
Artesia, CA 90701-6628

Mailing address

1303 Via Santiago Unit C
Corona, CA 92882-3828
Phone (714) 395-3451

Other identifiers

IdentifierTypeStateIssuer
93134MedicaidCA

Other providers in Artesia, CA

All providers in Artesia, CA · Dental Assistant in California

Sources for this page

Verify at the official NPI Registry.