Individual
MIRANDA MARQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2209 BATAAN RD, REDONDO BEACH, CA 90278-1404
(310) 714-2876
Mailing address
2209 BATAAN RD, REDONDO BEACH, CA 90278-1404
(310) 714-2876
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
76646
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
76646
—
CA
Enumeration date
01/24/2017
Last updated
01/24/2017
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