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General NPI Number Information
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NPI Number | 1932924149
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Entity Type | Individual
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Provider Name | YURIDIA MICHELLE AVALOS DDS
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Gender | Female
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 3755 MURPHY CANYON RD STE D
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City | SAN DIEGO
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State | CA
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Zip | 92123-4412
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Country | US
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Telephone | 858-331-1160
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Fax |
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Provider Business Mailing Address
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Address Line | MARINERO NO. 47
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City | YURIRIA
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State | GUANAJUATO
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Zip | 38940
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 108671
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License Number State | CA
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