Provider Demographics
NPI:1760020002
Name:DELGADO PEREZ, ERNESTO (DDS)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:DELGADO PEREZ
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 1:855 JEFFERSON AVE UNIT 3362
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94064-7222
Mailing Address - Country:US
Mailing Address - Phone:650-218-9662
Mailing Address - Fax:
Practice Address - Street 1:31754 TEMECULA PKWY STE E
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6805
Practice Address - Country:US
Practice Address - Phone:951-694-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1045991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA104599OtherDENTAL LICENSE