Provider Demographics
NPI:1871636845
Name:MAMANI, CESAR (DDS)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:MAMANI
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 1:1328 S MISSION RD
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-4006
Mailing Address - Country:US
Mailing Address - Phone:760-451-2730
Mailing Address - Fax:760-451-2700
Practice Address - Street 1:22675 ALESSANDRO BLVD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-8551
Practice Address - Country:US
Practice Address - Phone:951-571-2300
Practice Address - Fax:951-571-2330
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP70275GOtherPACT
COFHC70275GOtherMEDI-CAL
COFHC70275GOtherMEDI-CAL