Provider Demographics
NPI:1518137272
Name:AVENIDO, CECILIA RACQUEL HEMEDEZ (DMD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA RACQUEL
Middle Name:HEMEDEZ
Last Name:AVENIDO
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 1:66 PARKGROVE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-1597
Mailing Address - Country:US
Mailing Address - Phone:650-515-1991
Mailing Address - Fax:
Practice Address - Street 1:2400 WESTBOROUGH BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5404
Practice Address - Country:US
Practice Address - Phone:650-515-1991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-08
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55677122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist