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General NPI Number Information
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NPI Number | 1033245345
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Entity Type | Individual
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Provider Name | MARIA CAMILA BORRERO FONSECA D.D.S
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Gender | Female
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 569 W LOWELL AVE STE 200
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City | TRACY
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State | CA
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Zip | 95376-3084
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Country | US
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Telephone | 310-498-8167
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Fax | 209-832-5885
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Provider Business Mailing Address
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Address Line | 569 W LOWELL AVE STE 200
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City | TRACY
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State | CA
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Zip | 95376-3084
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Country | US
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Telephone | 310-498-8167
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Fax | 209-832-5885
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 51046
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License Number State | CA
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