Healthcare Provider Details

I. General information

NPI: 1518821479
Provider Name (Legal Business Name): GEMA HIGUERA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2939 ALTA VIEW DR
SAN DIEGO CA
92139-3394
US

IV. Provider business mailing address

2737 PIKAKE ST
SAN DIEGO CA
92154-4271
US

V. Phone/Fax

Practice location:
  • Phone: 619-267-8772
  • Fax:
Mailing address:
  • Phone: 619-642-6178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: