# CENTRO MEDICO AND DENTAL INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568256329
- **Authorized official:** MRS. VALERIA SOUCHUTSKI (ADMINISTRATION)
- **Authorized official phone:** (310) 383-9295

## Contact information

- **Practice address:** 2417 S. SAN PEDRO ST., LOS ANGELES, CA 90011-1518
- **Practice address phone:** (213) 749-3934
- **Practice address fax:** (213) 749-0994
- **Mailing address:** 417 S WETHERLY DR., BEVERLY HILLS, CA 90211-3519
- **Mailing address phone:** (310) 383-9295
- **Mailing address fax:** (213) 749-0994

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 04/07/2025
- **Last updated:** 12/11/2025