Healthcare Provider Details

I. General information

NPI: 1629900667
Provider Name (Legal Business Name): AXEL BARBA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7122 UNIVERSITY AVE
LA MESA CA
91942-5926
US

IV. Provider business mailing address

5490 SEACLIFF PL UNIT 51
SAN DIEGO CA
92154-6695
US

V. Phone/Fax

Practice location:
  • Phone: 619-698-5471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: