MEDICARE: DR. MARIA CELICA PELLEGRINI D.D.S.

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	45953	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D45953	OTHER	CA	DENTI CAL

General Provider Information

NPI Number	:	1548227184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA CELICA PELLEGRINI D.D.S.

Provider Business Mailing Address
First Line	:	14435 HAMLIN ST
Second Line	:	SUITE #210
City	:	VAN NUYS
State	:	CA
Zip	:	91401-6205
Country	:	US
Telephone Number	:	818-908-4090
Fax Number	:	818-908-4023

Provider Business Practice Location Address
First Line	:	14435 HAMLIN ST
Second Line	:	SUITE #210
City	:	VAN NUYS
State	:	CA
Zip	:	91401-6205
Country	:	US
Telephone Number	:	818-908-4090
Fax Number	:	818-908-4023

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/08/2007

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