Provider Demographics
NPI:1134252224
Name:ENCINAS, ELENA CABALLES (DDS)
Entity type:Individual
Prefix:DR
First Name:ELENA
Middle Name:CABALLES
Last Name:ENCINAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19121 1/2 BLOOMFIELD AVENUE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2514
Mailing Address - Country:US
Mailing Address - Phone:562-860-5740
Mailing Address - Fax:
Practice Address - Street 1:19121 1 2 BLOOMFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2514
Practice Address - Country:US
Practice Address - Phone:562-860-5740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA482571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice