Healthcare Provider Details

I. General information

NPI: 1720760903
Provider Name (Legal Business Name): NADIA K GERMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE DEL PACIFICO 1184
TIJUANA BC
22500
MX

IV. Provider business mailing address

644 E SAN YSIDRO BLVD STE G176
SAN YSIDRO CA
92173-3126
US

V. Phone/Fax

Practice location:
  • Phone: 664-252-6200
  • Fax: 619-908-1095
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. NADIA KARELY GERMAN
Title or Position: DENTIST
Credential: DDS
Phone: 664-252-6200