1285064915 NPI number — MILAGROS A LOO DDS

Table of content: (NPI 1285064915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285064915 NPI number — MILAGROS A LOO DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILAGROS A LOO DDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285064915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
746 S ALVARADO ST
Provider Second Line Business Mailing Address:
SUITE 8
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90057-4066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-989-6859
Provider Business Mailing Address Fax Number:
213-989-6933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
746 S ALVARADO ST
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-4066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-989-6859
Provider Business Practice Location Address Fax Number:
213-989-6933
Provider Enumeration Date:
11/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LOO
Authorized Official First Name:
MILAGROS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
213-989-6859

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  26167 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1417140047 . This is a "TYPE 1 NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com