1144336033 NPI number — LA MESA DENTAL GROUP

Table of content: MR. JOSE LUIS ZESATI JR. (NPI 1144928334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144336033 NPI number — LA MESA DENTAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LA MESA DENTAL GROUP
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:
1144336033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7872 LA MESA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91941-3633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-464-1211
Provider Business Mailing Address Fax Number:
619-464-3211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7872 LA MESA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-3633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-464-1211
Provider Business Practice Location Address Fax Number:
619-464-3211
Provider Enumeration Date:
08/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CAMPANELLA
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
SALVATORE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
619-464-1211

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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