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6505 Rosemead Blvd Ste 201 Pico Rivera CA 90660-3543 | |
| (562) 942-1062 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 6505 Rosemead Blvd Ste 201, Pico Rivera, California |
| Authorized Official Name and Position | Sage Monroe Humphries (OWNER) |
| Authorized Official Contact | 7149975961 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
6505 Rosemead Blvd Ste 201 Pico Rivera CA 90660-3543 Ph: (562) 942-1062 | 6505 Rosemead Blvd Ste 201 Pico Rivera CA 90660-3543 Ph: (562) 942-1062 |
| NPI Number | 1477067106 |
|---|---|
| Provider Enumeration Date | 11/16/2017 |
| Last Update Date | 04/04/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477067106 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 53072 (California) | Primary |
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