Provider Demographics
NPI:1578832630
Name:SKINNER, ROCHELLE R
Entity Type:Individual
Prefix:DR
First Name:ROCHELLE
Middle Name:R
Last Name:SKINNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 S SHERBOURNE DR APT 303
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4488
Mailing Address - Country:US
Mailing Address - Phone:310-895-9885
Mailing Address - Fax:323-939-6620
Practice Address - Street 1:1520 S SHERBOURNE DR APT 303
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4442
Practice Address - Country:US
Practice Address - Phone:310-885-9885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54813122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist