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General NPI Number Information
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NPI Number | 1538989355
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Entity Type | Organization
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Legal Business Name | ESTEBAN ASCENCIO
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 2468 JOSE CLEMENTE OROZCO STE 403
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City | TIJUANA
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State | BC
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Zip | 22010
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Country | MX
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Telephone | 664-252-6200
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Fax | 562-366-0560
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Provider Business Mailing Address
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Address Line | 1219 PORTER RD
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City | NORFOLK
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State | VA
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Zip | 23511-1223
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Country | US
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Telephone | 562-352-0417
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Fax | 562-366-0560
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Authorized Official
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Title or Position | DENTIST
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Name | DR. ESTEBAN ASCENCIO
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Credential | DDS
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Telephone | 562-352-0417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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