Healthcare Provider Details

I. General information

NPI: 1841490703
Provider Name (Legal Business Name): CARLOS A MAYOR NORIEGA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CARLOS ALBERTO MAYOR

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 MAGNOLIA AVE
RIVERSIDE CA
92506
US

IV. Provider business mailing address

678 3RD AVE
CHULA VISTA CA
91910-5736
US

V. Phone/Fax

Practice location:
  • Phone: 951-680-1777
  • Fax:
Mailing address:
  • Phone: 619-662-4100
  • Fax: 619-591-9616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number55420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: