Provider Demographics
NPI:1821654633
Name:RANGEL, MARIA R (RDA)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:R
Last Name:RANGEL
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 1:6215 HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-1821
Mailing Address - Country:US
Mailing Address - Phone:323-243-6643
Mailing Address - Fax:
Practice Address - Street 1:6215 HOLMES AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-1821
Practice Address - Country:US
Practice Address - Phone:323-243-6643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126800000XDental ProvidersDental AssistantGroup - Multi-Specialty