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General NPI Number Information
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NPI Number | 1245695485
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Entity Type | Individual
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Provider Name | JORGE LUIS NAVIDAD MONJARDIN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | BLVD. SANCHEZ TABOADA 9250-9 ZONA RIO
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City | TIJUANA
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State | CA
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Zip | 22900
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Country | MX
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Telephone | 011526646847040
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Fax |
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Provider Business Mailing Address
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Address Line | 4364 BONITA RD # 233
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City | BONITA
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State | CA
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Zip | 91902-1421
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2804299
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License Number State | ZZ
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