Luis, Modesto
Luis, Modesto is an individual health care provider with primary practice located at 4444 Tweedy Blvd , South Gate CA 90280-6304. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Luis, Modesto can be contacted via phone (323) 564-2444.Contact Information
Primary practice address
4444 Tweedy Blvd
South Gate CA 90280-6304
Phone: (323) 564-2444
Fax: (323) 249-7565
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 36401 | California |
Profile Details
| NPI number | 1720134091 |
|---|---|
| LBN Legal business name | Luis, Modesto |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 26th, 2007 |
| Last updated | Jul 9th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1720134091 | NPPES |
| California | MEDICAID | D36401 |
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