Provider Demographics
NPI:1114221819
Name:CONTRERAS-CERRILLO, ANA O (DDS)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:O
Last Name:CONTRERAS-CERRILLO
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 1:511 E SAN YSIDRO BLVD
Mailing Address - Street 2:#231
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-3150
Mailing Address - Country:US
Mailing Address - Phone:619-606-0372
Mailing Address - Fax:
Practice Address - Street 1:511 E SAN YSIDRO BLVD
Practice Address - Street 2:#231
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-3150
Practice Address - Country:US
Practice Address - Phone:619-606-0372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541321223G0001X
CA49001126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No126800000XDental ProvidersDental Assistant