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General NPI Number Information
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NPI Number | 1881352094
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Entity Type | Individual
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Provider Name | DR. SERGIO NEVAREZ
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Gender | Male
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Dates
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Enumeration Date | 12/04/2021
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Last Update Date | 12/04/2021
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Provider Practice Location Address
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Address Line | HERMENEGILDO GALEANA 8093 A4
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City | TIJUANA BC
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State | MEXICO
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Zip | 22000
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Country | MX
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Telephone | 664-207-3677
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Fax |
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Provider Business Mailing Address
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Address Line | HERMENEGILDO GALEANA 8093 A4
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City | TIJUANA BC
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State | MEXICO
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Zip | 22000
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Country | MX
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Telephone |
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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 | 7621380
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License Number State | ZZ
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