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General NPI Number Information
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NPI Number | 1538619259
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Entity Type | Organization
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Legal Business Name | MARIA ANGELES RACELIS, D.M.D., A DENTAL CORPORATION
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 2415 SAN PABLO DAM RD STE 108
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City | SAN PABLO
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State | CA
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Zip | 94806-3947
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Country | US
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Telephone | 510-237-4680
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Fax | 510-237-5619
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Provider Business Mailing Address
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Address Line | 2415 SAN PABLO DAM RD STE 108
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City | SAN PABLO
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State | CA
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Zip | 94806-3947
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Country | US
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Telephone | 510-237-4680
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Fax | 510-237-5619
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA ANGELES RACELIS
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Credential | D.M.D.
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Telephone | 510-237-4680
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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 |
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License Number State |
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