Provider Demographics
NPI:1871730721
Name:MARCERNARO-REYES, RUTH DANELIA (RDA)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:DANELIA
Last Name:MARCERNARO-REYES
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 TENAYA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-6546
Mailing Address - Country:US
Mailing Address - Phone:323-567-3040
Mailing Address - Fax:
Practice Address - Street 1:3727 TENAYA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6546
Practice Address - Country:US
Practice Address - Phone:323-567-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44556126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant