Provider Demographics
NPI:1457368425
Name:PENA, REBECCA IRENE ALCAZAREN (DMD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA IRENE
Middle Name:ALCAZAREN
Last Name:PENA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:REBECCA IRENE
Other - Middle Name:ALCAZAREN
Other - Last Name:WARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:5445 DEL AMO BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2760
Mailing Address - Country:US
Mailing Address - Phone:562-920-1726
Mailing Address - Fax:562-920-1728
Practice Address - Street 1:5445 DEL AMO BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2760
Practice Address - Country:US
Practice Address - Phone:562-920-1726
Practice Address - Fax:562-920-1728
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA49181OtherLIC NUMBER
CA1416870OtherUNITED CONCORDIA
CAG9242401OtherMEDICAL DENTICAL ST OF CA
CAB4918101OtherHEALTH FAMILIES
CAB4918101OtherHEALTH FAMILIES
CAB4918101OtherHEALTH FAMILIES