Healthcare Provider Details

I. General information

NPI: 1235738527
Provider Name (Legal Business Name): LORENA MALPICA DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 E REDD RD STE B
EL PASO TX
79912-1294
US

IV. Provider business mailing address

545 E REDD RD STE B
EL PASO TX
79912-1294
US

V. Phone/Fax

Practice location:
  • Phone: 915-581-6675
  • Fax:
Mailing address:
  • Phone: 915-581-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number36802
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: