MEDICARE: MRS. RUTH JANNET FIGUEROA LOPEZ D.D.S.

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	4929040	ZZ

General Provider Information

NPI Number	:	1417315722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RUTH JANNET FIGUEROA LOPEZ D.D.S.

Provider Business Mailing Address
First Line	:	4364 BONITA RD #233
Second Line	:
City	:	BONITA
State	:	CA
Zip	:	91902-1421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	BLVD CUCAPAH 19961-9
Second Line	:	AMPLIACION LOMA BONITA
City	:	TIJUANA
State	:	BAJA CALIFORNIA
Zip	:	22205
Country	:	MX
Telephone Number	:	011526646611624
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2016
Last Update Date	:	02/01/2016

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