Provider Demographics
NPI:1538492269
Name:TUNA, OMAR ALFREDO
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:ALFREDO
Last Name:TUNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 W 74TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-5113
Mailing Address - Country:US
Mailing Address - Phone:323-758-3886
Mailing Address - Fax:323-563-3434
Practice Address - Street 1:816 WEST 74TH STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044
Practice Address - Country:US
Practice Address - Phone:323-758-3886
Practice Address - Fax:323-563-3434
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant