1104983758 NPI number — DR. MARIA CRISTINA ESGUERRA MANIEGO DMD

Table of content: DR. MARIA CRISTINA ESGUERRA MANIEGO DMD (NPI 1104983758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104983758 NPI number — DR. MARIA CRISTINA ESGUERRA MANIEGO DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANIEGO
Provider First Name:
MARIA CRISTINA
Provider Middle Name:
ESGUERRA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MANIEGO
Provider Other First Name:
MA. CRISTINA
Provider Other Middle Name:
ESGUERRA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1104983758
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
508 GIBSON DR
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95678-5794
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-412-5468
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 GIBSON DR
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95678-5794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-772-6777
Provider Business Practice Location Address Fax Number:
916-789-0333
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  51616 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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