Basic Information
Provider Information
NPI: 1609905447
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ENCINA
FirstName: ROSE MARIE
MiddleName: BARRANTA
NamePrefix:  
NameSuffix:  
Credential: DENTAL ASSISTANT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1514 TOWNSEND AVE
Address2:  
City: SAN JOSE
State: CA
PostalCode: 951313028
CountryCode: US
TelephoneNumber: 6504935000
FaxNumber:  
Practice Location
Address1: 3801 MIRANDA AVE
Address2:  
City: PALO ALTO
State: CA
PostalCode: 943041207
CountryCode: US
TelephoneNumber: 6504935000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/05/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
126800000X  Y Dental ProvidersDental Assistant 

No ID Information.


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