Individual
DR. DANTE ATIENZA BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
875 N WESTERN AVE, LOS ANGELES, CA 90029-3759
(323) 258-7568
(323) 258-7498
Mailing address
875 N WESTERN AVE, LOS ANGELES, CA 90029-3759
(323) 258-7568
(323) 258-7498
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
00A440791
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A440791
BLUE CROSS BLUE SHIELD
CA
05
—
00A440791
—
CA
Enumeration date
11/20/2006
Last updated
08/02/2011
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