Individual
MARISA PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14340 ALICANTE RD, LA MIRADA, CA 90638-3607
(626) 607-6642
Mailing address
14340 ALICANTE RD, LA MIRADA, CA 90638-3607
(626) 607-6642
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
HAP845
CA
Other
Enumeration date
04/22/2022
Last updated
04/22/2022
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