Individual
MARK ANTHONY CARBAJAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DENTAL ASSISTANT
Contact information
Practice address
12121 WILSHIRE BLVD STE 1111, LOS ANGELES, CA 90025-1188
(213) 451-1313
Mailing address
2244 W 27TH ST, LOS ANGELES, CA 90018-2529
(323) 766-8154
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
449-735654
CA
Other
Enumeration date
02/18/2009
Last updated
02/18/2009
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