Provider Demographics
NPI:1285122358
Name:PASCUA, CLAUDIA BERENICE (RDH)
Entity type:Individual
Prefix:MS
First Name:CLAUDIA
Middle Name:BERENICE
Last Name:PASCUA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:CLAUDIA
Other - Middle Name:BERENICE
Other - Last Name:LOPEZ-RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:170 INNER LOOP ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:170 INNER LOOP ROAD
Practice Address - Street 2:
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:719-526-5537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29674124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist