Healthcare Provider Details

I. General information

NPI: 1053494815
Provider Name (Legal Business Name): CHERRYL REMORCA GELUZ D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 WESTBOROUGH BLVD STE 207
SOUTH SAN FRANCISCO CA
94080-5413
US

IV. Provider business mailing address

2400 WESTBOROUGH BLVD STE 207
SOUTH SAN FRANCISCO CA
94080-5413
US

V. Phone/Fax

Practice location:
  • Phone: 650-624-4021
  • Fax: 650-355-9170
Mailing address:
  • Phone: 650-624-4021
  • Fax: 650-355-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: