Healthcare Provider Details

I. General information

NPI: 1720534886
Provider Name (Legal Business Name): PARISSA NESSA BAIERA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 IMPERIAL AVE
SAN DIEGO CA
92101-7638
US

IV. Provider business mailing address

5155 W POINT LOMA BLVD APT 8
SAN DIEGO CA
92107-1353
US

V. Phone/Fax

Practice location:
  • Phone: 619-233-8500
  • Fax:
Mailing address:
  • Phone: 301-755-7993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number100781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: