Healthcare Provider Details

I. General information

NPI: 1568133437
Provider Name (Legal Business Name): DDS SHARILYN THERESE MONIZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3424 1ST AVE
SAN DIEGO CA
92103-4802
US

IV. Provider business mailing address

3424 1ST AVE
SAN DIEGO CA
92103-4802
US

V. Phone/Fax

Practice location:
  • Phone: 619-722-9500
  • Fax:
Mailing address:
  • Phone: 619-722-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SHARILYN THERESE MONIZ
Title or Position: OWNER
Credential: DDS
Phone: 619-722-9500