Provider Demographics
NPI:1932761988
Name:MONTERO, PELIN AYSE ECE
Entity Type:Individual
Prefix:DR
First Name:PELIN
Middle Name:AYSE ECE
Last Name:MONTERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 OFARRELL ST APT 802
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-5282
Mailing Address - Country:US
Mailing Address - Phone:305-905-8700
Mailing Address - Fax:
Practice Address - Street 1:2522 DANA ST STE 101
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2803
Practice Address - Country:US
Practice Address - Phone:510-487-1813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-30
Last Update Date:2019-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1037601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice