1306181037 NPI number — ELVIS BAQUERO DDS, INC.

Table of content: DR. CAROL ANN ZELTZER MD (NPI 1154901221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306181037 NPI number — ELVIS BAQUERO DDS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELVIS BAQUERO DDS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1306181037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 1 BOX 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NIPTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92364-9735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-856-1056
Provider Business Mailing Address Fax Number:
760-856-1050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100826 NIPTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NIPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-856-1056
Provider Business Practice Location Address Fax Number:
760-856-1050
Provider Enumeration Date:
12/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BAQUERO
Authorized Official First Name:
ELVIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
760-856-1056

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  49059 , 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)





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