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General NPI Number Information
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NPI Number | 1063083939
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Entity Type | Organization
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Legal Business Name | GUADALUPE L PEREIRA A PROF CORP
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Dates
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Enumeration Date | 07/01/2021
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 144 W CARSON ST
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City | CARSON
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State | CA
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Zip | 90745-2601
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Country | US
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Telephone | 310-835-4088
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Fax |
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Provider Business Mailing Address
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Address Line | 144 W CARSON ST
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City | CARSON
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State | CA
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Zip | 90745-2601
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Country | US
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Telephone | 310-835-4088
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MARIA TERESA CARRETTA
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Credential |
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Telephone | 562-715-6135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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