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General NPI Number Information
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NPI Number | 1598124034
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Entity Type | Individual
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Provider Name | RACHELE ANGELA MARIANO DDS
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Gender | Female
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Dates
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Enumeration Date | 02/11/2016
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Last Update Date | 05/14/2021
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Provider Practice Location Address
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Address Line | 1275 30TH ST
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City | SAN DIEGO
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State | CA
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Zip | 92154-3476
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Country | US
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Telephone | 619-662-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 1625 VIA ROSA
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City | BALDWIN PARK
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State | CA
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Zip | 91706-5974
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Country | US
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Telephone | 626-483-9655
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 102316
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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