Provider Demographics
NPI:1699252759
Name:PARRA, ROSA M (RDA)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:M
Last Name:PARRA
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:M
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDA
Mailing Address - Street 1:20508 ARLINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-1424
Mailing Address - Country:US
Mailing Address - Phone:562-441-2634
Mailing Address - Fax:
Practice Address - Street 1:12121 WILSHIRE BLVD STE 1111
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1188
Practice Address - Country:US
Practice Address - Phone:310-820-9933
Practice Address - Fax:310-820-0588
Is Sole Proprietor?:No
Enumeration Date:2018-07-22
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60761126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA60761Medicaid