Provider Demographics
NPI:1790161552
Name:PERPETUA MADRILEJO DENTAL OFFICE INC.
Entity Type:Organization
Organization Name:PERPETUA MADRILEJO DENTAL OFFICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERPETUA
Authorized Official - Middle Name:GALGUERA
Authorized Official - Last Name:MADRILEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-991-7300
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26472261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1639388838OtherDENTI - CAL