1396925921 NPI number — DR. MARIA GABRIELA ECHAVERRY-CENTENO DDS

Table of content: DR. MARIA GABRIELA ECHAVERRY-CENTENO DDS (NPI 1396925921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396925921 NPI number — DR. MARIA GABRIELA ECHAVERRY-CENTENO DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ECHAVERRY-CENTENO
Provider First Name:
MARIA
Provider Middle Name:
GABRIELA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
N/A
Provider Other First Name:
N/A
Provider Other Middle Name:
N/A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
N/A
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1396925921
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93703-6230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-974-6392
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2841 TULARE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93721-1320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-222-2238
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/12/2007

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: 122300000X , with the licence number:  56580 , 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)





Copyright © 2007-2025 www.npivalidator.com