=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295522183
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA JOSE MUCINO ESCOBEDO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2025
-----------------------------------------------------
Last Update Date | 04/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9840 CARMEL MOUNTAIN RD
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92129-2812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-240-9953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1445 TOWN CENTER DR APT 1442
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91915-4233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-513-4097
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 110904
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------