Individual
MYLENE PALENCIA FERNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDA
Contact information
Practice address
12730 HAWTHORNE BLVD, SUITE D, HAWTHORNE, CA 90250-3919
(310) 644-4000
Mailing address
1014 COTA AVE APT 3, TORRANCE, CA 90501-2166
(310) 291-8414
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
38102
CA
Other
Enumeration date
08/16/2011
Last updated
08/16/2011
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