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General NPI Number Information
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NPI Number | 1255735379
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Entity Type | Organization
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Legal Business Name | ALEJANDRA FLORES VIRGIL
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | MAR ADRIATICO 10239-4
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City | TIJUANA
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State | TIJUANA
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Zip | 22010
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Country | MX
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Telephone | 619-646-7461
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Fax |
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Provider Business Mailing Address
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Address Line | 416 W SAN YSIDRO BLVD SUITE L-1617
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City | SAN YSIDRO
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State | CA
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Zip | 92173-2443
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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 | OWNER
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Name | DR. ALEJANDRA FLORES
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Credential | D.D.S.
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Telephone | 619-646-7461
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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 | 6468458
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License Number State | ZZ
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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 | 6468458
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License Number State | ZZ
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