Provider Demographics
NPI:1548227184
Name:PELLEGRINI, MARIA CELICA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CELICA
Last Name:PELLEGRINI
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 1:14435 HAMLIN ST
Mailing Address - Street 2:SUITE #210
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-6205
Mailing Address - Country:US
Mailing Address - Phone:818-908-4090
Mailing Address - Fax:818-908-4023
Practice Address - Street 1:14435 HAMLIN ST
Practice Address - Street 2:SUITE #210
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-6205
Practice Address - Country:US
Practice Address - Phone:818-908-4090
Practice Address - Fax:818-908-4023
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD45953OtherDENTI CAL