Healthcare Provider Details

I. General information

NPI: 1295240331
Provider Name (Legal Business Name): MARIA WERNER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA TEJEDA

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 NEILSON ST
WATSONVILLE CA
95076-2468
US

IV. Provider business mailing address

45 NEILSON ST ATTN: DENTAL DEPT.
WATSONVILLE CA
95076-2468
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-8250
  • Fax: 831-707-2777
Mailing address:
  • Phone: 831-728-8250
  • Fax: 831-707-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number25377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: