Healthcare Provider Details

I. General information

NPI: 1124886908
Provider Name (Legal Business Name): ELSA ANZALDO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLV AGUA CALIENTE 9150 L18
TIJUANA BAJA CALIFORNIA
22015
MX

IV. Provider business mailing address

591 TELEGRAPH CANYON RD STE 318
CHULA VISTA CA
91910-6436
US

V. Phone/Fax

Practice location:
  • Phone: 619-272-9021
  • Fax:
Mailing address:
  • Phone: 619-272-9021
  • Fax: 619-329-9663

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. ELSA CECILIA ANZALDO FELIX
Title or Position: DENTIST
Credential: DDS
Phone: 619-272-9021