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General NPI Number Information
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NPI Number | 1104555291
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Entity Type | Individual
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Provider Name | DR. JENNIFER ARCE CACHO
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Gender | Female
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 520 BROADWAY STE 1
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City | CHULA VISTA
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State | CA
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Zip | 91910-5376
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Country | US
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Telephone | 619-202-4751
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Fax |
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Provider Business Mailing Address
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Address Line | 830 REGULO PL APT 2016
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City | CHULA VISTA
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State | CA
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Zip | 91910-7722
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Country | US
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Telephone | 619-354-0898
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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 | 019033696
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 108174
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License Number State | CA
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