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15418 Hawthorne Blvd Ste A Lawndale CA 90260-3828 | |
| (310) 679-0697 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 15418 Hawthorne Blvd, Lawndale, California |
| Authorized Official Name and Position | Rosario I Holland (PRESIDENT) |
| Authorized Official Contact | 3106790697 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
15418 Hawthorne Blvd Ste A Lawndale CA 90260-3828 Ph: (310) 679-0697 | 15418 Hawthorne Blvd Ste A Lawndale CA 90260-3828 Ph: (310) 679-0697 |
| NPI Number | 1750645420 |
|---|---|
| Provider Enumeration Date | 06/27/2012 |
| Last Update Date | 06/27/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750645420 | NPI | - | NPPES |
| B57147 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 57147 (California) | Primary |
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