MEDICARE: JANICE NAZARENO 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	1223G0001X	General Practice Dentistry	59691	CA

General Provider Information

NPI Number	:	1710296215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE NAZARENO DDS

Provider Business Mailing Address
First Line	:	8163 RIMRIDGE LN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-1133
Country	:	US
Telephone Number	:	858-549-4946
Fax Number	:

Provider Business Practice Location Address
First Line	:	8163 RIMRIDGE LN
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-1133
Country	:	US
Telephone Number	:	858-549-4946
Fax Number	:

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

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	09/30/2010

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