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2440 River Road Suite 140 Norco CA 92860 | |
| (310) 820-9933 | |
| (310) 820-0408 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 2440 River Road, Norco, California |
| Authorized Official Name and Position | Miguel Reyes (Q/A CONTRACT COMPLIANCE MANAGER) |
| Authorized Official Contact | 3104094225 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12121 Wilshire Blvd Ste 1111 Los Angeles CA 90025-1188 Ph: (310) 820-9933 | 2440 River Road Suite 140 Norco CA 92860 Ph: (310) 820-9933 |
| NPI Number | 1942713417 |
|---|---|
| Provider Enumeration Date | 11/07/2017 |
| Last Update Date | 11/07/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942713417 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 39862 (California) | Primary |
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