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General NPI Number Information
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NPI Number | 1801334073
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Entity Type | Individual
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Provider Name | MARIA L DERAMIREZ
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Gender | Female
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | CALLE H 224 COLONIA NUEVA
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City | MEXICALI
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State | BAJA CALIFORNIA
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Zip | 21100
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Country | MX
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Telephone | 760-592-1827
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Fax |
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Provider Business Mailing Address
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Address Line | 2310 M L KING ST
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City | CALEXICO
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State | CA
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Zip | 92231-1737
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Country | US
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Telephone | 760-592-1827
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Fax | 760-357-6166
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 715329
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License Number State | ZZ
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