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General NPI Number Information
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NPI Number | 1639988694
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Entity Type | Organization
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Legal Business Name | LOURDES IRENE ESTUPINAN BARRON
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Dates
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Enumeration Date | 01/04/2025
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Last Update Date | 01/04/2025
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Provider Practice Location Address
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Address Line | CAMPILLO 110-10
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City | NOGALES
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State | SONORA
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Zip | 84030
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Country | MX
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Telephone | 619-272-9021
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Fax | 619-329-9663
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Provider Business Mailing Address
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Address Line | 1062 N MARIPOSA RD
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City | NOGALES
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State | AZ
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Zip | 85621-1047
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Country | US
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Telephone | 619-270-9021
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | LOURDES IRENE ESTUPINAN BARRON
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Credential | DDS
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Telephone | 619-272-9021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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