Provider Demographics
NPI:1235263203
Name:QUIJANO, ANNA VALERA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:VALERA
Last Name:QUIJANO
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 1:2400 WESTBOROUGH BLVD
Mailing Address - Street 2:SUITE 202 B
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5404
Mailing Address - Country:US
Mailing Address - Phone:650-871-8485
Mailing Address - Fax:650-871-8486
Practice Address - Street 1:2400 WESTBOROUGH BLVD
Practice Address - Street 2:SUITE 202 B
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5404
Practice Address - Country:US
Practice Address - Phone:650-871-8485
Practice Address - Fax:650-871-8486
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice