Provider Demographics
NPI:1245062751
Name:GONZALEZ AREBALO, MARY KIMBERLY (RDH, HAP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KIMBERLY
Last Name:GONZALEZ AREBALO
Suffix:
Gender:F
Credentials:RDH, HAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 ZEMCO DR
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-4061
Mailing Address - Country:US
Mailing Address - Phone:619-708-4278
Mailing Address - Fax:
Practice Address - Street 1:7510 ZEMCO DR
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-4061
Practice Address - Country:US
Practice Address - Phone:619-708-4278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH29595124Q00000X
CAHAP1088124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist