Healthcare Provider Details

I. General information

NPI: 1700317914
Provider Name (Legal Business Name): GUADALUPE PEREZ-RINCON RDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST
SANTA ANA CA
92701-4599
US

IV. Provider business mailing address

405 W 5TH ST
SANTA ANA CA
92701-4599
US

V. Phone/Fax

Practice location:
  • Phone: 714-350-3253
  • Fax:
Mailing address:
  • Phone: 714-350-3253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number60428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: