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General NPI Number Information
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NPI Number | 1528216595
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Entity Type | Organization
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Legal Business Name | DENTAL CARE OF RANCHO BERNARDO
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | 12120 ALTA CARMEL CT SUITE 410C
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City | SAN DIEGO
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State | CA
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Zip | 92128-3864
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Country | US
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Telephone | 858-385-9188
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Fax |
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Provider Business Mailing Address
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Address Line | 12120 ALTA CARMEL CT SUITE 410C
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City | SAN DIEGO
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State | CA
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Zip | 92128-3864
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Country | US
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Telephone | 858-385-9188
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Fax |
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Authorized Official
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Title or Position | CEO/DENTIST
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Name | DR. BERNABE BARR URBANO AMBROSIO
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Credential | DMD
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Telephone | 858-385-9188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 50720
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License Number State | CA
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