Provider Demographics
NPI:1083615157
Name:HERNANDEZ-CABANBAN, MILAGROSA MARIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MILAGROSA
Middle Name:MARIA
Last Name:HERNANDEZ-CABANBAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1309
Mailing Address - Country:US
Mailing Address - Phone:562-461-2991
Mailing Address - Fax:562-461-2981
Practice Address - Street 1:5911 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1309
Practice Address - Country:US
Practice Address - Phone:562-461-2991
Practice Address - Fax:562-461-2981
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39965122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist