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General NPI Number Information
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NPI Number | 1144389164
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Entity Type | Individual
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Provider Name | MARIA LOURDES PEREZ-DE LA ROSA D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 10/15/2015
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Provider Practice Location Address
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Address Line | 5132 N FRESNO ST
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City | FRESNO
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State | CA
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Zip | 93710-6826
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Country | US
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Telephone | 559-226-5700
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Fax | 559-226-0774
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Provider Business Mailing Address
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Address Line | 5132 N FRESNO ST
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City | FRESNO
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State | CA
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Zip | 93710-6826
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Country | US
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Telephone | 559-226-5700
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Fax | 559-226-0774
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 48167
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License Number State | CA
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