Healthcare Provider Details

I. General information

NPI: 1639988694
Provider Name (Legal Business Name): LOURDES IRENE ESTUPINAN BARRON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2025
Last Update Date: 01/04/2025
Certification Date: 01/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAMPILLO 110-10
NOGALES SONORA
84030
MX

IV. Provider business mailing address

1062 N MARIPOSA RD
NOGALES AZ
85621-1047
US

V. Phone/Fax

Practice location:
  • Phone: 619-272-9021
  • Fax: 619-329-9663
Mailing address:
  • Phone: 619-270-9021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LOURDES IRENE ESTUPINAN BARRON
Title or Position: PROVIDER
Credential: DDS
Phone: 619-272-9021