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General NPI Number Information
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NPI Number | 1487103016
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Entity Type | Organization
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Legal Business Name | GRICELDA FLORES MORENO
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | C. 21 DE MARZO #487
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City | MEXICALI
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State | BAJA CALIFORNIA
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Zip | 21370
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Country | MX
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Telephone | 760-356-8696
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Fax |
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Provider Business Mailing Address
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Address Line | 120 ROCKWOOD AVE STE A
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City | CALEXICO
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State | CA
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Zip | 92231-4700
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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. GRICELDA FLORES
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Credential | DDS
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Telephone | 760-356-8696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2421374
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License Number State | ZZ
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