=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518842434
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVELYN STEPHANY STEPHANY VILLEDA MARTINEZ DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2025
-----------------------------------------------------
Last Update Date | 08/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1040 TIERRA DEL REY STE 207
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91910-7865
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-482-1992
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 157 VIRGINIA AVE # 2051
-----------------------------------------------------
City | SAN YSIDRO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92173-2717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | 112221
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------