Provider Demographics
NPI:1326190034
Name:NELLY A PARAYNO DMD INC
Entity Type:Organization
Organization Name:NELLY A PARAYNO DMD INC
Other - Org Name:HACIENDA FAMILY DENTISTRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARAYNO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:626-917-5980
Mailing Address - Street 1:1855 N HACIENDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744
Mailing Address - Country:US
Mailing Address - Phone:626-917-5980
Mailing Address - Fax:626-917-5980
Practice Address - Street 1:1855 N HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744
Practice Address - Country:US
Practice Address - Phone:626-917-5980
Practice Address - Fax:626-917-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD39062OtherDENTICAL