Provider Demographics
NPI:1700977907
Name:RIFORMO, EVANGELINE MALABED (DMD)
Entity Type:Individual
Prefix:DR
First Name:EVANGELINE
Middle Name:MALABED
Last Name:RIFORMO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 GELLERT BLVD
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015
Mailing Address - Country:US
Mailing Address - Phone:650-754-0995
Mailing Address - Fax:650-754-0998
Practice Address - Street 1:419 GELLERT BLVD
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015
Practice Address - Country:US
Practice Address - Phone:650-754-0995
Practice Address - Fax:650-754-0998
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist