Individual
CARLITO BRIONES BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
111 E 220TH ST, SUITE A-B, CARSON, CA 90745-3060
(310) 549-1035
Mailing address
111 E 220TH ST, SUITE A-B, CARSON, CA 90745-3060
(310) 549-1035
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
49468
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
521848
MEDI-CAL, DENTI-CAL
CA
Enumeration date
03/02/2007
Last updated
07/08/2007
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