Provider Demographics
NPI:1689732935
Name:ROXAS, LEONCIA M (DMD)
Entity type:Individual
Prefix:DR
First Name:LEONCIA
Middle Name:M
Last Name:ROXAS
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 1:3130 W 6TH ST
Mailing Address - Street 2:SUITE1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1702
Mailing Address - Country:US
Mailing Address - Phone:213-382-5650
Mailing Address - Fax:213-382-1443
Practice Address - Street 1:3130 W 6TH ST
Practice Address - Street 2:SUITE1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1702
Practice Address - Country:US
Practice Address - Phone:213-382-5650
Practice Address - Fax:213-382-1443
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91735-01OtherPROVIDER NUMBER