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General NPI Number Information
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NPI Number | 1851999007
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Entity Type | Individual
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Provider Name | NAZ KHATIBLOU DDS
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Gender | Female
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Dates
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Enumeration Date | 10/10/2020
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Last Update Date | 10/10/2020
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Provider Practice Location Address
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Address Line | 31726 RANCHO VIEJO RD STE 103
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2723
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Country | US
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Telephone | 949-493-7007
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Fax |
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Provider Business Mailing Address
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Address Line | 19 DAYTONA DR
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-5177
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Country | US
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Telephone | 949-637-7173
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 105346
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License Number State | CA
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