MEDICARE: MRS. MARCELA I PEREZ ZEPEDA

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	122300000X	Dentist	32163	CA

General Provider Information

NPI Number	:	1215060769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARCELA I PEREZ ZEPEDA

Provider Business Mailing Address
First Line	:	1638 SUMMITRIDGE DR
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-4335
Country	:	US
Telephone Number	:	909-396-1926
Fax Number	:	562-698-1014

Provider Business Practice Location Address
First Line	:	6711 GREENLEAF AVE
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90601-4110
Country	:	US
Telephone Number	:	562-698-0054
Fax Number	:	562-698-1014

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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