=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730227414
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARILOU D. QUIROZ DMD., INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2007
-----------------------------------------------------
Last Update Date | 07/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1392 E PALOMAR ST STE. 201
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91913-1892
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-941-1820
-----------------------------------------------------
Fax | 619-941-1821
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1392 E PALOMAR ST STE 201
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91913-1893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-941-1820
-----------------------------------------------------
Fax | 619-941-1821
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | MR. RODOLFO P QUIROZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 619-395-4606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 45760
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------