Healthcare Provider Details

I. General information

NPI: 1265801849
Provider Name (Legal Business Name): PATRICIA C. RANGEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10709 MISIO DE SAN JAVIER, ZONA RIO
TIJUANA BAJA CALIFORNIA
22010
MX

IV. Provider business mailing address

4364 BONITA RD # 233
BONITA CA
91902-1421
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: SILVIA VILLALPANDO
Title or Position: ATTENDING DENTIST
Credential: D.D.S.
Phone: 619-591-8551