Provider Demographics
NPI:1710371505
Name:FARENBAUGH, GIZELLE PERA (DDS)
Entity type:Individual
Prefix:
First Name:GIZELLE
Middle Name:PERA
Last Name:FARENBAUGH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 COLORADO BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1062
Mailing Address - Country:US
Mailing Address - Phone:323-258-2885
Mailing Address - Fax:
Practice Address - Street 1:2525 COLORADO BLVD STE A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1062
Practice Address - Country:US
Practice Address - Phone:323-258-2885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1005021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice