Basic Information
| Provider Information | |||||||||
| NPI: | 1770052854 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORAIS | ||||||||
| FirstName: | FERNANDA | ||||||||
| MiddleName: | SCANDELARI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 906 N DOHENY DR APT 505 | ||||||||
| Address2: | |||||||||
| City: | WEST HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900693163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734620648 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7903 ATLANTIC AVE STE G | ||||||||
| Address2: | |||||||||
| City: | CUDAHY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902015926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237732200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2018 | ||||||||
| LastUpdateDate: | 08/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 061038 | NY | N | Dental Providers | Dentist | 122300000X | 106940 | CA | Y | Dental Providers | Dentist |
No ID Information.