Individual
EMMANUEL MARASIGAN TAYAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4000 LA RICA AVE STE D, BALDWIN PARK, CA 91706-3163
(626) 430-9171
Mailing address
709 S GREENWOOD AVE, MONTEBELLO, CA 90640-5515
(310) 216-8585
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
62115
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
62115
—
CA
Enumeration date
03/10/2021
Last updated
03/10/2021
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