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Provider Information for 1508947292

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: 1508947292

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


Name Value
NPI 1508947292
Enumeration Date 2006-10-18
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 1626 PIERCE ST APT 16
SAN FRANCISCO, CA 94115-5224
United States

Phone: 415-238-1680 | Fax:
View Map External Link
Primary Practice Address 133 PLAZA DR
VALLEJO, CA 94591-3703
United States

Phone: 707-557-6245 | Fax: 707-557-0968
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 1223G0001X - Dentist General Practice CA 50315