Healthcare Provider Details

I. General information

NPI: 1043423742
Provider Name (Legal Business Name): AMEXUS MEXICO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 S ARCHIBALD AVE SUITE H-289
ONTARIO CA
91761-9001
US

IV. Provider business mailing address

3045 S ARCHIBALD AVE SUITE H-289
ONTARIO CA
91761-9001
US

V. Phone/Fax

Practice location:
  • Phone: 909-758-8075
  • Fax:
Mailing address:
  • Phone: 909-758-8075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD TOVAR
Title or Position: PRESIDENT
Credential:
Phone: 909-758-8075