Provider Demographics
NPI:1174970123
Name:BELENDA VILLARUEL ABANILLA DENTAL CORPORATION
Entity type:Organization
Organization Name:BELENDA VILLARUEL ABANILLA DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BELENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABANILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-584-1171
Mailing Address - Street 1:3017 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5827
Mailing Address - Country:US
Mailing Address - Phone:323-584-1171
Mailing Address - Fax:
Practice Address - Street 1:3017 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5827
Practice Address - Country:US
Practice Address - Phone:323-584-1171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELENDA VILLARUEL ABANILLA DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39223305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service