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General NPI Number Information
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NPI Number | 1023288628
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Entity Type | Individual
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Provider Name | FEDERICO JESUS TIZNADO D.D.S
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Gender | Male
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 7877 PARKWAY DR STE 2B
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City | LA MESA
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State | CA
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Zip | 91942-2000
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Country | US
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Telephone | 619-463-6758
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Fax | 619-463-6797
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Provider Business Mailing Address
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Address Line | 1538 LARKSPUR CT
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City | CHULA VISTA
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State | CA
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Zip | 91913-1507
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Country | US
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Telephone | 619-482-5264
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Fax | 619-482-5264
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 40033
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License Number State | CA
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