Provider Demographics
NPI:1821148750
Name:MARCOS, ALICIA AREVALO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:AREVALO
Last Name:MARCOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3998 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1050
Mailing Address - Country:US
Mailing Address - Phone:415-239-8511
Mailing Address - Fax:415-239-1366
Practice Address - Street 1:3998 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1050
Practice Address - Country:US
Practice Address - Phone:415-239-8511
Practice Address - Fax:415-239-1366
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA338951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice