| Sandra Calleros, A Professional Corp | |
|
131 W Grand Ave Suite B El Segundo CA 90245-3738 | |
| (310) 414-9564 | |
| (310) 414-9773 |
| Full Name | Sandra Calleros, A Professional Corp |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 131 W Grand Ave, El Segundo, California |
| Authorized Official Name and Position | Sandra Calleros (OWNER) |
| Authorized Official Contact | 3104149564 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sandra Calleros, A Professional Corp 131 W Grand Ave Suite B El Segundo CA 90245-3738 Ph: (310) 414-9564 | Sandra Calleros, A Professional Corp 131 W Grand Ave Suite B El Segundo CA 90245-3738 Ph: (310) 414-9564 |
| NPI Number | 1891188371 |
|---|---|
| Provider Enumeration Date | 03/09/2015 |
| Last Update Date | 03/09/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891188371 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 62902 (California) | Secondary |
| 1223G0001X | Dentist - General Practice | 35478 (California) | Primary |
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