Healthcare Provider Details

I. General information

NPI: 1871286013
Provider Name (Legal Business Name): NATALIA G BARGHOUTH DMD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E VIRGINIA ST SUITE 100
SAN JOSE CA
95112-5817
US

IV. Provider business mailing address

160 E VIRGINIA ST SUITE 100
SAN JOSE CA
95112-5817
US

V. Phone/Fax

Practice location:
  • Phone: 408-579-6178
  • Fax: 408-579-6143
Mailing address:
  • Phone: 408-579-6178
  • Fax: 408-579-6143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number108820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: