Individual
MAURO MIRAMONTES III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3380 LA SIERRA AVE, RIVERSIDE, CA 92503-5271
(951) 354-9999
Mailing address
66031 1ST ST, DESERT HOT SPRINGS, CA 92240-3636
(760) 620-4524
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
79237
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
79237
—
CA
Enumeration date
01/06/2017
Last updated
01/06/2017
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