Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 54132 | CA |
Y | 213EG0000X | General Practice | 54132 | CA |
N | 126800000X | Dental Assistant | 49001 | CA |
NPI | 1114221819 |
---|---|
Provider Name | Ana O Contreras-Cerrillo |
First Address | San Ysidro, CA 92173-3150 |
Second Address | San Ysidro, CA 92173-3150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2011 |
Last Update Date | 10/01/2011 |