MEDICARE: MR. HECTOR JAVIER LOPEZ AMEZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	648834	ZZ

General Provider Information

NPI Number	:	1396904579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HECTOR JAVIER LOPEZ AMEZ DDS

Provider Business Mailing Address
First Line	:	1995 MOSS LANDING AVE
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91913-1607
Country	:	US
Telephone Number	:	619-819-2988
Fax Number	:

Provider Business Practice Location Address
First Line	:	PASEO DE LOS HEROES
Second Line	:	# 9415-1A ZONA RIO
City	:	TIJUANA
State	:	BAJA CALIFORNIA
Zip	:	22320
Country	:	MX
Telephone Number	:	011526646847358
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	06/03/2008

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