Provider Demographics
NPI:1699255414
Name:CERNA, CARISSA LEANA (DDS)
Entity type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:LEANA
Last Name:CERNA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MARINE CORPS RECRUITING DEPOT BUILDING 595
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92140-0001
Mailing Address - Country:US
Mailing Address - Phone:619-524-4005
Mailing Address - Fax:
Practice Address - Street 1:MARINE CORPS RECRUITING DEPOT BUILDING 595
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92140-0001
Practice Address - Country:US
Practice Address - Phone:619-524-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist