Healthcare Provider Details

I. General information

NPI: 1447804232
Provider Name (Legal Business Name): TERESA GAMEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AV. JORGE LOPEZ COLLADA#2095, FOVISTE
MEXICALI BAJA CALIFORNIA
21038
MX

IV. Provider business mailing address

308 E 3RD ST. PMB 41021
CALEXICO CA
92231
US

V. Phone/Fax

Practice location:
  • Phone: 686-333-0301
  • Fax: 858-430-3143
Mailing address:
  • Phone: 686-333-0301
  • Fax: 858-430-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. TERESA GAMEZ
Title or Position: OWNER
Credential: DDS
Phone: 686-333-0301