Provider Demographics
NPI:1104371368
Name:MARIE EKINS RDHAP CORP
Entity type:Organization
Organization Name:MARIE EKINS RDHAP CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:EKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:800-280-1608
Mailing Address - Street 1:10831 CANELO RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-1902
Mailing Address - Country:US
Mailing Address - Phone:800-280-1608
Mailing Address - Fax:844-804-2343
Practice Address - Street 1:10831 CANELO RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604-1902
Practice Address - Country:US
Practice Address - Phone:800-280-1608
Practice Address - Fax:844-804-2343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA633125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes125K00000XDental ProvidersAdvanced Practice Dental TherapistGroup - Single Specialty