Individual
GILBERT N/A PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDA
Contact information
Practice address
1205 RENAISSANCE PKWY STE 240, RIALTO, CA 92376-2418
(909) 253-0490
Mailing address
1205 RENAISSANCE PKWY STE 240, RIALTO, CA 92376-2418
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
RDA93312
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RDA93312
—
CA
Enumeration date
12/18/2019
Last updated
12/20/2019
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