Provider Demographics
NPI:1013194117
Name:CORAZON C RABONZA DDS INC
Entity Type:Organization
Organization Name:CORAZON C RABONZA DDS INC
Other - Org Name:HEALTHY SMILES DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA CORAZON
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:RABONZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-788-3168
Mailing Address - Street 1:14622 VENTURA BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-788-3168
Mailing Address - Fax:818-788-0610
Practice Address - Street 1:14622 VENTURA BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-788-3168
Practice Address - Fax:818-788-0610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA455201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty