MEDICARE: ALEJANDRA FLORES VIRGIL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	6468458	ZZ
2	1223G0001X	General Practice Dentistry	6468458	ZZ

General Provider Information

NPI Number	:	1255735379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEJANDRA FLORES VIRGIL

Provider Business Mailing Address
First Line	:	416 W SAN YSIDRO BLVD
Second Line	:	SUITE L-1617
City	:	SAN YSIDRO
State	:	CA
Zip	:	92173-2443
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	MAR ADRIATICO 10239-4
Second Line	:
City	:	TIJUANA
State	:	TIJUANA
Zip	:	22010
Country	:	MX
Telephone Number	:	619-646-7461
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALEJANDRA FLORES
Credential	:	D.D.S.
Telephone Number	:	619-646-7461

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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Directions to “ALEJANDRA FLORES VIRGIL ” Practice Location

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