Provider Demographics
NPI:1508589847
Name:MINEO ESCARENO, SCARLETT ANAI (DDS)
Entity Type:Individual
Prefix:
First Name:SCARLETT
Middle Name:ANAI
Last Name:MINEO ESCARENO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SCARLETT
Other - Middle Name:ANAI
Other - Last Name:ESCARENO MAZUCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3025 1/2 VAN BUREN PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3059
Mailing Address - Country:US
Mailing Address - Phone:760-333-4047
Mailing Address - Fax:
Practice Address - Street 1:8812 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2658
Practice Address - Country:US
Practice Address - Phone:562-394-1322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108069122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist