Provider Demographics
NPI:1639388838
Name:MADRILEJO, PERPETUA GALGUERA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:PERPETUA
Middle Name:GALGUERA
Last Name:MADRILEJO
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 1:6273 MISSION ST
Mailing Address - Street 2:200
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014
Mailing Address - Country:US
Mailing Address - Phone:650-991-7300
Mailing Address - Fax:650-756-0966
Practice Address - Street 1:6273 MISSION ST
Practice Address - Street 2:200
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014
Practice Address - Country:US
Practice Address - Phone:650-991-7300
Practice Address - Fax:650-756-0966
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA264721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA82647201OtherDENTICAL
CAG9803301OtherSTATE GOVT PROGRAM