Provider Demographics
NPI:1619049319
Name:PATERNO, JOSE ARENAS (DDS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ARENAS
Last Name:PATERNO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12475 BRICKELLIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4155
Mailing Address - Country:US
Mailing Address - Phone:858-538-0499
Mailing Address - Fax:
Practice Address - Street 1:11295 CAMINO RUIZ STE 1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4658
Practice Address - Country:US
Practice Address - Phone:858-537-9077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA401081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice