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General NPI Number Information
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NPI Number | 1679087670
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Entity Type | Organization
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Legal Business Name | LILIA CAMACHO RASCON D.D.S.
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 11/29/2017
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Provider Practice Location Address
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Address Line | AVE. MARINAO LEE
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City | LOS ALGODONES
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State | BAJA CALIFORNIA
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Zip | 21970
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Country | MX
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Telephone | 664-200-2469
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Fax |
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Provider Business Mailing Address
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Address Line | 4275 EXECUTIVE SQUARE SUITE 200
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City | LA JOLLA
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State | CA
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Zip | 92037-9123
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Country | US
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Telephone | 619-488-3200
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Fax | 866-272-6924
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Authorized Official
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Title or Position | DENTIST
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Name | MRS. LILIA CAMACHO RASCON
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Credential | D.D.S.
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Telephone | 619-488-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 8142083
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License Number State | ZZ
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