Healthcare Provider Details

I. General information

NPI: 1770236325
Provider Name (Legal Business Name): ALAN GUIZAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE GOBERNADOR LUGO 9531-10, COLONIA DAVILA
TIJUANA BAJA CALIFORNIA
22044
MX

IV. Provider business mailing address

5345 TOSCANA WAY APT 5210
SAN DIEGO CA
92122-5315
US

V. Phone/Fax

Practice location:
  • Phone: 619-272-9021
  • Fax:
Mailing address:
  • Phone:
  • 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. ALAN GUIZAR
Title or Position: DENTIST
Credential: DDS
Phone: 619-272-9021