Provider Demographics
NPI:1619792132
Name:CARMONA, CRISTINA (DENTAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:CARMONA
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-6105
Mailing Address - Country:US
Mailing Address - Phone:323-789-5610
Mailing Address - Fax:323-789-5616
Practice Address - Street 1:7821 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-2358
Practice Address - Country:US
Practice Address - Phone:323-789-5610
Practice Address - Fax:323-789-5616
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant