Healthcare Provider Details

I. General information

NPI: 1386519866
Provider Name (Legal Business Name): MIGUEL OSUNA MILLAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASEO DEL CENTENARIO 9580
TIJUANA B.C.
22000
MX

IV. Provider business mailing address

PO BOX 433152
SAN YSIDRO CA
92143-3152
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MIGUEL A OSUNA MILLAN
Title or Position: DENTIST
Credential: DDS
Phone: 619-272-9021