Healthcare Provider Details

I. General information

NPI: 1780495267
Provider Name (Legal Business Name): BERHA ANGUIANO ANGUIANO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 03/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2916 COYOACAN
JUAREZ MEXICO
32300
MX

IV. Provider business mailing address

6101 GATEWAY WEST, SPC 520, PMB 85
EL PASO TX
79925
US

V. Phone/Fax

Practice location:
  • Phone: 915-631-5260
  • Fax: 915-613-5260
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7545864
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: