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General NPI Number Information
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NPI Number | 1013778992
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Entity Type | Individual
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Provider Name | CODRINA ALEXANDRA BASTON GERIGUIS DDS
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Gender | Female
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Dates
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Enumeration Date | 01/18/2024
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 2670 GARDEN ST
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City | TITUSVILLE
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State | FL
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Zip | 32796-3176
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Country | US
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Telephone | 321-267-1526
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Fax |
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Provider Business Mailing Address
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Address Line | 9304 MOSS PRESERVE PKWY APT 306
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City | ORLANDO
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State | FL
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Zip | 32832-6726
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Country | US
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Telephone | 760-805-4588
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 109604
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License Number State | CA
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