Healthcare Provider Details

I. General information

NPI: 1952048043
Provider Name (Legal Business Name): JOSE ISRAEL CAMBEROS D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASEO DEL CENTERNARIO #9580-2205A NEW CITY MEDICAL PLAZA
TIJUANA BAJA CALIF
22010
MX

IV. Provider business mailing address

4364 BONITA ROAD #233
BONITA CA
91902-1421
US

V. Phone/Fax

Practice location:
  • Phone: 664-685-8014
  • Fax: 866-864-5572
Mailing address:
  • Phone: 619-421-6632
  • Fax: 866-864-5572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6110368
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: