Provider Demographics
NPI:1447879507
Name:RONALD CRUZ ABARO DENTAL CORPORATION
Entity type:Organization
Organization Name:RONALD CRUZ ABARO DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAVIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-835-6839
Mailing Address - Street 1:2360 S AZUSA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1540
Mailing Address - Country:US
Mailing Address - Phone:626-839-5010
Mailing Address - Fax:626-839-5152
Practice Address - Street 1:2360 S AZUSA AVE STE B
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1540
Practice Address - Country:US
Practice Address - Phone:626-839-5010
Practice Address - Fax:626-839-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental