Provider Demographics
NPI:1801038039
Name:TOVAR QUINONEZ, BETZABEL IRIS ARHELY (RDA)
Entity Type:Individual
Prefix:
First Name:BETZABEL
Middle Name:IRIS ARHELY
Last Name:TOVAR QUINONEZ
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 1:6541 SAN VINCENTE ST
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-2938
Mailing Address - Country:US
Mailing Address - Phone:562-529-3576
Mailing Address - Fax:
Practice Address - Street 1:6541 SAN VINCENTE ST
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-2938
Practice Address - Country:US
Practice Address - Phone:562-529-3576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70550126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant