Healthcare Provider Details

I. General information

NPI: 1588969703
Provider Name (Legal Business Name): N. KERI D.D.S. APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 VISTA WAY
OCEANSIDE CA
92055
US

IV. Provider business mailing address

2226 OTAY LAKES RD STE 260
CHULA VISTA CA
91915
US

V. Phone/Fax

Practice location:
  • Phone: 619-216-7336
  • Fax: 619-216-2084
Mailing address:
  • Phone: 619-216-7336
  • Fax: 619-216-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number42542
License Number StateCA

VIII. Authorized Official

Name: ROSARIO SANCHEZ
Title or Position: BILLING CLERK
Credential:
Phone: 619-585-8500