Provider Demographics
NPI:1376786442
Name:CLIMACO, CLAUDIA
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:CLIMACO
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 1:321 E FAIRVIEW AVE
Mailing Address - Street 2:APTO #104
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1968
Mailing Address - Country:US
Mailing Address - Phone:818-546-2663
Mailing Address - Fax:
Practice Address - Street 1:1725 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1000
Practice Address - Country:US
Practice Address - Phone:213-413-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-19
Last Update Date:2009-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64000126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant