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Provider Information for 1326252420

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1326252420

Calendar   Last Updated:  2007-07-08
  Certification Date: 


Name Value
NPI 1326252420
Enumeration Date 2007-05-09
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 68 TERRACE RD
WALNUT CREEK, CA 94597-3462
United States

Phone: 925-935-1455 | Fax:
View Map External Link
Primary Practice Address 441 JOAQUIN AVE
SAN LEANDRO, CA 94577-4997
United States

Phone: 510-352-2632 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223P0221X - Dentist Pediatric Dentistry CA 46479