MEDICARE: LUIS J RIBEROS 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	56466	CA

General Provider Information

NPI Number	:	1386808400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS J RIBEROS DDS

Provider Business Mailing Address
First Line	:	31654 RANCHO VIEJO RD STE I-1
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-6754
Country	:	US
Telephone Number	:	949-240-4337
Fax Number	:	949-240-7337

Provider Business Practice Location Address
First Line	:	31654 RANCHO VIEJO RD STE I-1
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-6754
Country	:	US
Telephone Number	:	949-240-4337
Fax Number	:	949-240-7337

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

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	07/21/2022

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