Most Relevant Information
Provider Data
| NPI Number: | 1003827551 |
| Provider Name: | DIANA MARCELA MEDINA DDS |
| Entity Type: | Individual |
| Taxonomy Code: | 1223S0112X |
| Specialty: | Dentist |
| License Number: | 50643 |
Most Important Dates
| Enumeration Date: | 08/10/2006 |
| Last Updated: | 07/08/2007 |
Provider Practice Location
11980 SAN VICENTE BLVD
SUITE 505
LOS ANGELES
CA
900495012
Practice Location Phone/Fax
| Phone: | 3108206691 |
| Fax: | 3108206041 |
Provider Mailing Location
10620 EASTBORNE AVE
APT # 302
LOS ANGELES
CA
900245985
Provider Mailing Phone/Fax
| Phone: | 3104906674 |
| Fax: |