Provider Demographics
NPI:1447349808
Name:PECAOCO, GERTRUDE M
Entity type:Individual
Prefix:DR
First Name:GERTRUDE
Middle Name:M
Last Name:PECAOCO
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 1:1925 W TEMPLE ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4970
Mailing Address - Country:US
Mailing Address - Phone:213-413-3910
Mailing Address - Fax:213-413-4078
Practice Address - Street 1:1925 W TEMPLE ST
Practice Address - Street 2:SUITE 214
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4970
Practice Address - Country:US
Practice Address - Phone:213-413-3910
Practice Address - Fax:213-413-4078
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist