MEDICARE: MRS. MARY KIMBERLY GONZALEZ AREBALO RDH, HAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	RDH29595	CA
2	124Q00000X	Dental Hygienist	HAP1088	CA

General Provider Information

NPI Number	:	1245062751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY KIMBERLY GONZALEZ AREBALO RDH, HAP

Provider Business Mailing Address
First Line	:	7510 ZEMCO DR
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-4061
Country	:	US
Telephone Number	:	619-708-4278
Fax Number	:

Provider Business Practice Location Address
First Line	:	7510 ZEMCO DR
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-4061
Country	:	US
Telephone Number	:	619-708-4278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2024
Last Update Date	:	08/14/2024

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