Healthcare Provider Details

I. General information

NPI: 1730607813
Provider Name (Legal Business Name): XOCHIPILLI BOJORQUEZ LEDESMA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GARZA ST #160
LOS ALGODONES BAJA CALIFORNIA
21972
MX

IV. Provider business mailing address

4275 EXECUTIVE SQUARE STE 200
LA JOLLA CA
92037-9123
US

V. Phone/Fax

Practice location:
  • Phone: 526-585-1733
  • Fax:
Mailing address:
  • Phone: 619-488-3200
  • Fax: 866-272-6924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5798689
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: