Provider Demographics
NPI:1881194512
Name:NEVAREZ, GILBERTO ANTONIO (RDH,RDHAP)
Entity Type:Individual
Prefix:MR
First Name:GILBERTO
Middle Name:ANTONIO
Last Name:NEVAREZ
Suffix:
Gender:M
Credentials:RDH,RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38709 SUMAC AVE
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-3739
Mailing Address - Country:US
Mailing Address - Phone:818-300-6572
Mailing Address - Fax:
Practice Address - Street 1:38709 SUMAC AVE
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-3739
Practice Address - Country:US
Practice Address - Phone:818-300-6572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAP320124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty