MEDICARE: DR. EDUARDO AUCENCIO PEREZ DE LA ROCHA DDS

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	1223G0001X	General Practice Dentistry	110774	CA

General Provider Information

NPI Number	:	1326865478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDUARDO AUCENCIO PEREZ DE LA ROCHA DDS

Provider Business Mailing Address
First Line	:	719 AMADOR AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91764-3605
Country	:	US
Telephone Number	:	909-358-7772
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 E WORKMAN AVE STE A
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91791-6626
Country	:	US
Telephone Number	:	626-634-3393
Fax Number	:

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

Provider Enumeration Date	:	09/20/2024
Last Update Date	:	09/20/2024

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