MEDICARE: PROF. KATYUSKA PAREDES LOPEZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	50967	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D50967	OTHER	CA	DENTI-CAL

General Provider Information

NPI Number	:	1083758296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. KATYUSKA PAREDES LOPEZ DDS

Provider Business Mailing Address
First Line	:	23318 OLIVE WOOD PLAZA DR STE C
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-5219
Country	:	US
Telephone Number	:	951-242-5585
Fax Number	:	951-242-5587

Provider Business Practice Location Address
First Line	:	23318 OLIVE WOOD PLAZA DR STE C
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-5219
Country	:	US
Telephone Number	:	951-242-5585
Fax Number	:	951-242-5587

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/21/2022

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