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8363 Reseda Blvd Ste 202 Northridge CA 91324-5908 | |
| (818) 405-0278 | |
| (626) 938-1238 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 8363 Reseda Blvd Ste 202, Northridge, California |
| Authorized Official Name and Position | Victor Magpili Rosales (PRESIDENT) |
| Authorized Official Contact | 6269381236 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
20530 E Arrow Hwy Ste A Covina CA 91724-1238 Ph: (626) 938-1236 | 8363 Reseda Blvd Ste 202 Northridge CA 91324-5908 Ph: (818) 405-0278 |
| NPI Number | 1225519903 |
|---|---|
| Provider Enumeration Date | 08/22/2018 |
| Last Update Date | 09/10/2019 |
| Medicare PECOS PAC ID | 8729317169 |
|---|---|
| Medicare Enrollment ID | O20190910001338 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225519903 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 55369 (California) | Primary |
| Provider Name | Victor Magpili Rosales |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1326174970 PECOS PAC ID: 9638408073 Enrollment ID: I20190910001593 |
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