Provider Demographics
NPI:1235310442
Name:PEREIRA, GUADALUPE LUSTRE (DMD)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:LUSTRE
Last Name:PEREIRA
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 1:155 E LOMITA BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745
Mailing Address - Country:US
Mailing Address - Phone:310-847-7777
Mailing Address - Fax:310-835-0199
Practice Address - Street 1:155 E LOMITA BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745
Practice Address - Country:US
Practice Address - Phone:310-847-7777
Practice Address - Fax:310-835-0199
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA415151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice