Provider Demographics
NPI:1861833998
Name:DR.KERI,A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR.KERI,A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-591-2642
Mailing Address - Street 1:2226 OTAY LAKES RD
Mailing Address - Street 2:STE A
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1010
Mailing Address - Country:US
Mailing Address - Phone:619-216-7336
Mailing Address - Fax:619-216-2084
Practice Address - Street 1:11943 EL CAMINO REAL
Practice Address - Street 2:STE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2597
Practice Address - Country:US
Practice Address - Phone:619-216-7336
Practice Address - Fax:619-216-2084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty