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General NPI Number Information
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NPI Number | 1689700114
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Entity Type | Individual
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Provider Name | GUADALUPE VELAZQUEZ VILLA DDS
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 215 3RD AVE
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City | CHULA VISTA
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State | CA
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Zip | 91910-2710
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Country | US
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Telephone | 619-427-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 8310 REGENTS RD UNIT 3F
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City | SAN DIEGO
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State | CA
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Zip | 92122-1347
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Country | US
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Telephone | 619-807-8524
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 40900
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License Number State | CA
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