Healthcare Provider Details

I. General information

NPI: 1699416099
Provider Name (Legal Business Name): CHRISTIAN CALZADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASEO MORELOS #887 COL INDUSTRIAL
TECATE BAJA CALIFORNIA
21430
MX

IV. Provider business mailing address

PO BOX 803
TECATE CA
91980-0803
US

V. Phone/Fax

Practice location:
  • Phone: 619-272-9021
  • Fax:
Mailing address:
  • Phone: 619-272-9021
  • Fax:

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: CHRISTIAN CALZADA
Title or Position: DENTIST
Credential: DDS
Phone: 619-272-9021