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General NPI Number Information
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NPI Number | 1710367651
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Entity Type | Organization
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Legal Business Name | LERIDA LIPUMANO-PICAZO DMD,A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/05/2015
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Last Update Date | 06/05/2015
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Provider Practice Location Address
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Address Line | 1415 S EL CAMINO REAL STE 2
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City | SAN MATEO
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State | CA
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Zip | 94402-3019
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Country | US
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Telephone | 650-343-0884
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Fax | 650-375-0231
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Provider Business Mailing Address
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Address Line | 1415 S EL CAMINO REAL STE 2
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City | SAN MATEO
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State | CA
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Zip | 94402-3019
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Country | US
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Telephone | 650-343-0884
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Fax | 650-375-0231
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Authorized Official
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Title or Position | DMD
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Name | LERIDA FELIZARDO LIPUMANO-PICAZO
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Credential |
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Telephone | 650-343-0884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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