Provider Demographics
NPI:1134614134
Name:RAFAEL POU DDS INC
Entity type:Organization
Organization Name:RAFAEL POU DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:POU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-514-3500
Mailing Address - Street 1:6040B ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-3119
Mailing Address - Country:US
Mailing Address - Phone:323-476-7558
Mailing Address - Fax:323-476-7576
Practice Address - Street 1:6040B ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-3119
Practice Address - Country:US
Practice Address - Phone:323-476-7558
Practice Address - Fax:323-476-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental