Provider Demographics
NPI:1780899260
Name:LIPUMANO-PICAZO, LERIDA FELIZARDO (DMD)
Entity type:Individual
Prefix:DR
First Name:LERIDA
Middle Name:FELIZARDO
Last Name:LIPUMANO-PICAZO
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 1:1415 S EL CAMINO REAL STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3019
Mailing Address - Country:US
Mailing Address - Phone:650-343-0884
Mailing Address - Fax:650-375-0231
Practice Address - Street 1:800 SOUTH B ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401
Practice Address - Country:US
Practice Address - Phone:650-343-0884
Practice Address - Fax:650-375-0231
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA408481223P0221X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223P0221XDental ProvidersDentistPediatric Dentistry