Provider Demographics
NPI:1598522997
Name:LANGARICA PERERA, NANCY MIRELLA
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:MIRELLA
Last Name:LANGARICA PERERA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:MIRELLA
Other - Last Name:PERERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDA
Mailing Address - Street 1:4476 TWEEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6359
Mailing Address - Country:US
Mailing Address - Phone:323-825-8300
Mailing Address - Fax:866-372-2719
Practice Address - Street 1:4476 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6359
Practice Address - Country:US
Practice Address - Phone:323-825-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71775126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant