1083252464 NPI number — DENISSE PATRICIA MACIAS DDS

Table of content: DENISSE PATRICIA MACIAS DDS (NPI 1083252464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083252464 NPI number — DENISSE PATRICIA MACIAS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACIAS
Provider First Name:
DENISSE
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083252464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3975 CAMINO DE LA PLZ
Provider Second Line Business Mailing Address:
STE 208 #1292
Provider Business Mailing Address City Name:
SAN YSIDRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-763-8258
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 EAST ORANGE AVENUE
Provider Second Line Business Practice Location Address:
APARTMENT E4
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-763-8258
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  104574 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 104574 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)