Healthcare Provider Details

I. General information

NPI: 1437217783
Provider Name (Legal Business Name): GUADALUPE L PEREIRA DMD APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 W CARSON ST
CARSON CA
90745-2601
US

IV. Provider business mailing address

144 W. CARSON ST., CARSON, CA 90745
CARSON CA
90745
US

V. Phone/Fax

Practice location:
  • Phone: 310-847-7777
  • Fax: 310-835-0199
Mailing address:
  • Phone: 310-847-7777
  • Fax: 310-835-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41515
License Number StateCA

VIII. Authorized Official

Name: MARIA TERESA CARRETTA
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 562-715-6135