Healthcare Provider Details

I. General information

NPI: 1245477363
Provider Name (Legal Business Name): SHELLAINE ALONSAGAY- DEL CAMPO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27725 STA. MARGARITA PARKWAY STE 270
MISSION VIIEJO CA
92691-6708
US

IV. Provider business mailing address

27725 STA. MARGARITA PARKWAY STE 270
MISSION VIIEJO CA
92691-6708
US

V. Phone/Fax

Practice location:
  • Phone: 949-951-0951
  • Fax: 949-951-0962
Mailing address:
  • Phone: 949-951-0951
  • Fax: 949-951-0962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number45850
License Number StateCA

VIII. Authorized Official

Name: DR. SHELLAINE ALONSAGAY- DEL CAMPO
Title or Position: PRESIDENT
Credential: DMD
Phone: 949-951-0951