Provider Demographics
NPI:1639463888
Name:IZVERNARI, PAULA MARIA SR
Entity Type:Individual
Prefix:MISS
First Name:PAULA
Middle Name:MARIA
Last Name:IZVERNARI
Suffix:SR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11262 BELLAIRE ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3004
Mailing Address - Country:US
Mailing Address - Phone:858-353-2917
Mailing Address - Fax:
Practice Address - Street 1:11262 BELLAIRE ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3004
Practice Address - Country:US
Practice Address - Phone:858-353-2917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60367122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist