Healthcare Provider Details

I. General information

NPI: 1205410370
Provider Name (Legal Business Name): ROCIO PIZARRO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MISION DE MULEGE #2009 STE 102
TIJUANA BAJA CALIFORNIA
22010
MX

IV. Provider business mailing address

4275 EXECUTIVE SQ STE 200
LA JOLLA CA
92037-1476
US

V. Phone/Fax

Practice location:
  • Phone: 619-488-3200
  • Fax: 619-908-1095
Mailing address:
  • Phone: 619-488-3200
  • Fax: 619-908-1095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. ROCIO PIZARRO
Title or Position: DENTIST
Credential: DDS
Phone: 619-488-3200