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General NPI Number Information
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NPI Number | 1124349311
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Entity Type | Individual
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Provider Name | GRICELDA PERALTA R.D.H, R.D.H.A.P.
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Gender | Female
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Dates
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Enumeration Date | 06/22/2010
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Last Update Date | 06/22/2010
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Provider Practice Location Address
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Address Line | 322 CULVER BLVD SUITE 187
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7704
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Country | US
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Telephone | 310-779-9712
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Fax |
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Provider Business Mailing Address
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Address Line | 322 CULVER BLVD SUITE 187
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7704
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Country | US
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Telephone | 310-779-9712
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 296
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 18576
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License Number State | CA
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