| Rebecca Irene A Pena D M D A Dental | |
|
5445 Del Amo Blvd Suite 103 Lakewood CA 90712-2760 | |
| (562) 920-1726 | |
| (562) 920-1728 |
| Full Name | Rebecca Irene A Pena D M D A Dental |
|---|---|
| Speciality | Dentist |
| Location | 5445 Del Amo Blvd, Lakewood, California |
| Authorized Official Name and Position | Rebecca Irene Alcazaren Pena (PRESIDENT) |
| Authorized Official Contact | 5629201726 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rebecca Irene A Pena D M D A Dental 5445 Del Amo Blvd Suite 103 Lakewood CA 90712-2760 Ph: (562) 920-1726 | Rebecca Irene A Pena D M D A Dental 5445 Del Amo Blvd Suite 103 Lakewood CA 90712-2760 Ph: (562) 920-1726 |
| NPI Number | 1306190095 |
|---|---|
| Provider Enumeration Date | 11/01/2012 |
| Last Update Date | 03/07/2023 |
| Medicare PECOS PAC ID | 0345570099 |
|---|---|
| Medicare Enrollment ID | O20190924001452 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306190095 | NPI | - | NPPES |
| 1457368425 | Other | CA | NPI TYPE 1 |
| 49181 | Other | CA | DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Rebecca Irene Alcazaren Pena |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1457368425 PECOS PAC ID: 3072843721 Enrollment ID: I20190924002140 |
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