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General NPI Number Information
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NPI Number | 1831938638
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Entity Type | Individual
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Provider Name | ROBERTO MANUEL SEVILLA DDS
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Gender | Male
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Dates
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Enumeration Date | 05/21/2024
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 1919 HIGHLAND AVE
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City | NATIONAL CITY
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State | CA
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Zip | 91950
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Country | US
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Telephone | 619-292-3043
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Fax |
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Provider Business Mailing Address
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Address Line | 1312 LINDSAY ST
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City | CHULA VISTA
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State | CA
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Zip | 91913
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Country | US
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Telephone | 619-836-2941
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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 | 110098
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License Number State | CA
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