Provider Demographics
NPI:1033651518
Name:ZEPEDA-MOLINA, SILVIA KARINA
Entity type:Individual
Prefix:
First Name:SILVIA
Middle Name:KARINA
Last Name:ZEPEDA-MOLINA
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 1:824 VINEYARD CREEK DR
Mailing Address - Street 2:APT 179
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-9006
Mailing Address - Country:US
Mailing Address - Phone:707-620-3295
Mailing Address - Fax:
Practice Address - Street 1:19270 SONOMA HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-5414
Practice Address - Country:US
Practice Address - Phone:707-939-6070
Practice Address - Fax:707-939-2272
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH 20834124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770669715OtherMEDI-CAL FQHC