Provider Demographics
NPI:1215060769
Name:PEREZ ZEPEDA, MARCELA I
Entity type:Individual
Prefix:MRS
First Name:MARCELA
Middle Name:I
Last Name:PEREZ ZEPEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:PROF
Other - First Name:MARCELA
Other - Middle Name:I
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1638 SUMMITRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4335
Mailing Address - Country:US
Mailing Address - Phone:909-396-1926
Mailing Address - Fax:562-698-1014
Practice Address - Street 1:6711 GREENLEAF AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4110
Practice Address - Country:US
Practice Address - Phone:562-698-0054
Practice Address - Fax:562-698-1014
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist