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General NPI Number Information
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NPI Number | 1801085758
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Entity Type | Individual
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Provider Name | MARIBEL VICENTE DMD
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Gender | Female
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/29/2007
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Provider Practice Location Address
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Address Line | 5555 JACKSON DR 210
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City | LA MESA
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State | CA
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Zip | 91942-2452
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Country | US
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Telephone | 619-462-3552
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Fax | 619-271-1514
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Provider Business Mailing Address
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Address Line | 5555 JACKSON DR 210
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City | LA MESA
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State | CA
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Zip | 91942-2452
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Country | US
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Telephone | 619-462-3552
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Fax | 619-271-1514
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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 | 42707
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License Number State | CA
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