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General NPI Number Information
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NPI Number | 1245516020
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Entity Type | Organization
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Legal Business Name | MARTHA L ITURRIAGA D.D.S INC
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 1000 S WHITE RD STE 210
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City | SAN JOSE
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State | CA
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Zip | 95127-3812
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Country | US
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Telephone | 408-259-2214
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 S WHITE RD STE 210
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City | SAN JOSE
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State | CA
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Zip | 95127-3812
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Country | US
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Telephone | 408-910-5725
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. MARTHA LOUISANA ITURRIAGA
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Credential | D.D.S
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Telephone | 408-259-2214
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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 | 60302
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License Number State | CA
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