Provider Demographics
NPI:1194916536
Name:CANTOS, RACHEL A (DMD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:A
Last Name:CANTOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 N VERMONT AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1749
Mailing Address - Country:US
Mailing Address - Phone:323-669-8659
Mailing Address - Fax:
Practice Address - Street 1:1233 N VERMONT AVE STE 6
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1749
Practice Address - Country:US
Practice Address - Phone:323-669-8659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38048122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA860768OtherUNITED CONCORDIA