Provider Demographics
NPI:1730445107
Name:CERNA, ANNABEL (RDH)
Entity type:Individual
Prefix:
First Name:ANNABEL
Middle Name:
Last Name:CERNA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ANNABEL
Other - Middle Name:
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:737 W CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6805
Mailing Address - Country:US
Mailing Address - Phone:209-385-5529
Mailing Address - Fax:209-383-1296
Practice Address - Street 1:725 W I ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3478
Practice Address - Country:US
Practice Address - Phone:209-826-1094
Practice Address - Fax:209-826-7808
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22035124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22035OtherHYGIENE LICENSES