Healthcare Provider Details

I. General information

NPI: 1447965561
Provider Name (Legal Business Name): DAVID A SOBERON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FRIDA KAHLO 14410-510
TIJUANA BC
22010
MX

IV. Provider business mailing address

4275 EXECUTIVE SQ STE 302
LA JOLLA CA
92037-9123
US

V. Phone/Fax

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

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. DAVID A SOBERON
Title or Position: DENTIST
Credential: DDS
Phone: 619-488-3200