DANTE A. BANTA, M.D., INC.
Ambulatory Health at Western Ave, Los Angeles, CA

License number
California A44079
Category
Ambulatory Health
Type
Primary Care
Owner
Name: DR. DANTE ATIENZA BANTA M.D.
Title: PRESIDENT
Phone: (323) 461-0777
Address
Address
875 N Western Ave, Los Angeles, CA 90029
National Provider ID: 1215100417
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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DANTE A. BANTA M.D., INC

875 N Western Ave, Los Angeles, CA 90029

Industry:
Medical Doctor's Office
Doing business as:
Dante Banta MD
Registration:
Mar 17, 1992
Phone:
(323) 461-0777 (Phone)
State ID:
C1704418
Business type:
Articles of Incorporation
President:
Dante A. Banta (President)
Agent:
Zenaida P Banta,Los Angeles, CA 90029 (Physical)

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