Healthcare Provider Details

I. General information

NPI: 1821589847
Provider Name (Legal Business Name): OLIVER GIRON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 PACIFIC AVE STE A-145
STOCKTON CA
95207-5100
US

IV. Provider business mailing address

38180 CAMARADA LN
MURRIETA CA
92563-3239
US

V. Phone/Fax

Practice location:
  • Phone: 209-323-7219
  • Fax:
Mailing address:
  • Phone: 951-445-1672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDDS105813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: