Healthcare Provider Details

I. General information

NPI: 1730762089
Provider Name (Legal Business Name): RAFAEL INFANTE D.D.S. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13569 POWAY RD
POWAY CA
92064-4715
US

IV. Provider business mailing address

13569 POWAY RD
POWAY CA
92064-4715
US

V. Phone/Fax

Practice location:
  • Phone: 858-486-3300
  • Fax: 858-486-5300
Mailing address:
  • Phone: 858-486-3300
  • Fax: 858-486-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RAFAEL E INFANTE
Title or Position: OWNER
Credential: D.D.S.
Phone: 858-486-3300