Provider Demographics
NPI:1093364770
Name:CERRITOS FAMILY DENAL CENTER
Entity Type:Organization
Organization Name:CERRITOS FAMILY DENAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEFA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELENDREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-330-6655
Mailing Address - Street 1:20106 PIONEER BLVD STE A&B
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7400
Mailing Address - Country:US
Mailing Address - Phone:562-474-1221
Mailing Address - Fax:
Practice Address - Street 1:20106 S BLVD STE A & B
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90701
Practice Address - Country:US
Practice Address - Phone:562-474-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental