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Provider Information for 1912195280

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1912195280

Calendar   Last Updated:  2008-04-17
  Certification Date: 


Name Value
NPI 1912195280
Enumeration Date 2007-10-11
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 1437 SILVER SPRINGS DR
CHULA VISTA, CA 91915-1567
United States

Phone: 619-216-3092 | Fax: 619-216-3092
View Map External Link
Primary Practice Address 7733 PALM ST STE 107
LEMON GROVE, CA 91945-2967
United States

Phone: 619-460-1991 | Fax: 619-460-1995
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice CA 54192