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General NPI Number Information
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NPI Number | 1992627889
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Entity Type | Individual
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Provider Name | MARTHA SOFIA ZALDIVAR RUENES
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Gender | Female
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 19071 BEAR VALLEY RD
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City | APPLE VALLEY
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State | CA
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Zip | 92308-2718
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Country | US
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Telephone | 909-256-9824
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Fax |
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Provider Business Mailing Address
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Address Line | HACIENDA LA NEGRETA 225A BALCONES DEL CAMPESTRE
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City | LEON
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State | GUANAJUATO
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Zip | 37138
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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 | 113670
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License Number State | CA
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