Provider Demographics
NPI:1669749123
Name:HA, MARIA JASMIN HIZO (RDH, RDHAP)
Entity type:Individual
Prefix:MISS
First Name:MARIA JASMIN
Middle Name:HIZO
Last Name:HA
Suffix:
Gender:F
Credentials:RDH, RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9702 BEVERLYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-1827
Mailing Address - Country:US
Mailing Address - Phone:213-446-2099
Mailing Address - Fax:
Practice Address - Street 1:9702 BEVERLYWOOD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1827
Practice Address - Country:US
Practice Address - Phone:213-446-2099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23597124Q00000X
CARDHAP780124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist