Provider Demographics
NPI:1508233222
Name:NEGRIETE-BLEAZARD, MARIA L (RDA)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:L
Last Name:NEGRIETE-BLEAZARD
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 E COLUMBIA ST
Mailing Address - Street 2:STE 32
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1620
Mailing Address - Country:US
Mailing Address - Phone:562-933-3141
Mailing Address - Fax:562-933-2049
Practice Address - Street 1:455 E COLUMBIA ST
Practice Address - Street 2:SUITE 32
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1620
Practice Address - Country:US
Practice Address - Phone:562-933-3141
Practice Address - Fax:562-933-2049
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22501126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant