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4000 La Rica Ave Suite D Baldwin Park CA 91706-3163 | |
| (626) 430-9171 | |
| (626) 430-9177 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 4000 La Rica Ave, Baldwin Park, California |
| Authorized Official Name and Position | Farhad Manavi (OWNER) |
| Authorized Official Contact | 3108209933 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4000 La Rica Ave Suite D Baldwin Park CA 91706-3163 Ph: (626) 430-9171 | 4000 La Rica Ave Suite D Baldwin Park CA 91706-3163 Ph: (626) 430-9171 |
| NPI Number | 1356686679 |
|---|---|
| Provider Enumeration Date | 11/28/2012 |
| Last Update Date | 06/27/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356686679 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 38558 (California) | Primary |
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