Individual
MR. FAVIO ALBERTO LEON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDA
Contact information
Practice address
2604 S. VERMONT AVE., #F, WEST COAST DENTAL GROUP, LOS ANGELES, CA 90007
(323) 731-3333
Mailing address
133 N RENO ST APT 208, LOS ANGELES, CA 90026-4678
(213) 858-8748
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
77346
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
77346
RDA LICENSE
CA
Enumeration date
03/13/2012
Last updated
03/13/2012
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