Individual
CERISA CLOUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
11980 SAN VICENTE BLVD STE 619, LOS ANGELES, CA 90049-6604
(310) 459-2303
Mailing address
11980 SAN VICENTE BLVD STE 619, LOS ANGELES, CA 90049-6604
(310) 459-2303
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
61688
CA
Other
Enumeration date
11/19/2012
Last updated
11/03/2025
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