Provider Demographics
NPI:1497226344
Name:USITA, PRIMER IGNACIO BAYANI (RDA)
Entity Type:Individual
Prefix:MRS
First Name:PRIMER IGNACIO
Middle Name:BAYANI
Last Name:USITA
Suffix:
Gender:M
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11635 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-6628
Mailing Address - Country:US
Mailing Address - Phone:562-924-4401
Mailing Address - Fax:
Practice Address - Street 1:11635 E. SOUTH STREET
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63792126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant