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General NPI Number Information
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NPI Number | 1871680843
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Entity Type | Individual
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Provider Name | MARIA ANGELES RACELIS D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 08/08/2016
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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 |
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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 |
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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 | 38586
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License Number State | CA
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