Provider Demographics
NPI:1043681729
Name:GAMA, BLANCA (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:
Last Name:GAMA
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 TORRANCE BLVD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4409
Mailing Address - Country:US
Mailing Address - Phone:310-933-3077
Mailing Address - Fax:310-982-2597
Practice Address - Street 1:4305 TORRANCE BLVD
Practice Address - Street 2:SUITE 505
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4409
Practice Address - Country:US
Practice Address - Phone:310-933-3077
Practice Address - Fax:310-982-2597
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338291223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33289OtherDENTAL LICENSE