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General NPI Number Information
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NPI Number | 1275357097
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Entity Type | Individual
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Provider Name | JAMIE ROSE TANCIATCO DE LEON
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Gender | Female
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Dates
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Enumeration Date | 11/08/2024
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 2835 HIGHLAND AVE
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City | NATIONAL CITY
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State | CA
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Zip | 91950-7404
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Country | US
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Telephone | 209-683-5640
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Fax |
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Provider Business Mailing Address
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Address Line | 784 VADA ST UNIT 1
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City | CHULA VISTA
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State | CA
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Zip | 91911-6456
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Country | US
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Telephone | 619-991-4005
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 37028
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License Number State | CA
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