Provider Demographics
NPI:1871700294
Name:RONQUILLO, ELSA MAGTANONG (DMD)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:MAGTANONG
Last Name:RONQUILLO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1762 DECOTO RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3524
Mailing Address - Country:US
Mailing Address - Phone:510-441-1148
Mailing Address - Fax:510-441-2842
Practice Address - Street 1:1762 DECOTO RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3524
Practice Address - Country:US
Practice Address - Phone:510-441-1148
Practice Address - Fax:510-441-2842
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA457651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice