Healthcare Provider Details

I. General information

NPI: 1790504033
Provider Name (Legal Business Name): ISABELA VACCARO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 S RANCHO SANTA FE RD UNIT G
SAN MARCOS CA
92078-2303
US

IV. Provider business mailing address

1408 HERMES AVE APT C
ENCINITAS CA
92024-1677
US

V. Phone/Fax

Practice location:
  • Phone: 760-744-3333
  • Fax:
Mailing address:
  • Phone: 760-557-9105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS109716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: