| |
1154 E Palmdale Blvd Palmdale CA 93550-4866 | |
(661) 947-2135 | |
(661) 947-5419 |
Full Name | |
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Speciality | Dentist |
Location | 1154 E Palmdale Blvd, Palmdale, California |
Authorized Official Name and Position | David Rabizadeh (OFFICER) |
Authorized Official Contact | 6619472135 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1154 E Palmdale Blvd Palmdale CA 93550-4866 Ph: (661) 947-2135 | 1154 E Palmdale Blvd Palmdale CA 93550-4866 Ph: (661) 947-2135 |
NPI Number | 1063963213 |
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Provider Enumeration Date | 10/21/2016 |
Last Update Date | 10/21/2016 |
Identifier | Type | State | Issuer |
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1063963213 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 41984 (California) | Secondary |
122300000X | Dentist | (California) | Primary |