Healthcare Provider Details

I. General information

NPI: 1538989355
Provider Name (Legal Business Name): ESTEBAN ASCENCIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2468 JOSE CLEMENTE OROZCO STE 403
TIJUANA BC
22010
MX

IV. Provider business mailing address

1219 PORTER RD
NORFOLK VA
23511-1223
US

V. Phone/Fax

Practice location:
  • Phone: 664-252-6200
  • Fax: 562-366-0560
Mailing address:
  • Phone: 562-352-0417
  • Fax: 562-366-0560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ESTEBAN ASCENCIO
Title or Position: DENTIST
Credential: DDS
Phone: 562-352-0417