Healthcare Provider Details

I. General information

NPI: 1043671100
Provider Name (Legal Business Name): ROGELIO MARTIN TURNER RDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S EUCLID AVE
SAN DIEGO CA
92114-6201
US

IV. Provider business mailing address

4140 ALTADENA AVE APT 4
SAN DIEGO CA
92105-2278
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-4100
  • Fax: 619-662-4194
Mailing address:
  • Phone: 619-838-5220
  • Fax: 619-662-4194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number55484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: