Healthcare Provider Details

I. General information

NPI: 1982946380
Provider Name (Legal Business Name): GHEETY ALLAHI RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2013
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12584 CAMARERO CT
SAN DIEGO CA
92130-2279
US

IV. Provider business mailing address

12584 CAMARERO CT
SAN DIEGO CA
92130-2279
US

V. Phone/Fax

Practice location:
  • Phone: 858-722-5047
  • Fax: 858-847-2200
Mailing address:
  • Phone: 858-722-5047
  • Fax: 858-847-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: