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General NPI Number Information
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NPI Number | 1124843271
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Entity Type | Individual
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Provider Name | LYMARI JAMILETTE DE LA RIVA VARGAS
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Gender | Female
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 1072 3RD AVE STE A
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City | CHULA VISTA
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State | CA
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Zip | 91911-2085
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Country | US
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Telephone | 619-425-5323
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Fax |
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Provider Business Mailing Address
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Address Line | 9902 JAMACHA BLVD SPC 23
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City | SPRING VALLEY
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State | CA
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Zip | 91977-8023
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Country | US
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Telephone | 619-463-0921
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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 | 107382
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License Number State | CA
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