Healthcare Provider Details

I. General information

NPI: 1134302763
Provider Name (Legal Business Name): DIANA CRISTINA VASQUEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 KUHN DR STE 203
CHULA VISTA CA
91914-4517
US

IV. Provider business mailing address

860 KUHN DR STE 203
CHULA VISTA CA
91914-4517
US

V. Phone/Fax

Practice location:
  • Phone: 619-656-9393
  • Fax: 619-656-6464
Mailing address:
  • Phone: 619-482-4237
  • Fax: 619-656-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number55929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: