Organization
DANTE A. BANTA, M.D., INC.
Active
Other names
Clinica Western
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANTE ATIENZA BANTA M.D. (PRESIDENT)
(323) 461-0777
Entity
Organization
Contact information
Practice address
875 N WESTERN AVE, LOS ANGELES, CA 90029-3759
(323) 461-0777
(323) 461-8035
Mailing address
875 N WESTERN AVE, LOS ANGELES, CA 90029-3759
(323) 461-0777
(323) 461-8035
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
A44079
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A440791
—
CA
Enumeration date
04/08/2008
Last updated
08/02/2011
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