Provider Demographics
NPI:1982255725
Name:PEREZ, ADRIANA S (DMD)
Entity type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:S
Last Name:PEREZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 W GRAND BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2059
Mailing Address - Country:US
Mailing Address - Phone:951-549-1111
Mailing Address - Fax:951-549-1190
Practice Address - Street 1:80 W GRAND BLVD STE 111
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2059
Practice Address - Country:US
Practice Address - Phone:951-549-1111
Practice Address - Fax:951-549-1190
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1044511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA104451OtherDENTIST