MEDICARE: DR. FRANCISCO VITAL 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	722460	ZZ

General Provider Information

NPI Number	:	1548528789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANCISCO VITAL D.D.S.

Provider Business Mailing Address
First Line	:	P.O. BOX 1611
Second Line	:
City	:	BONITA
State	:	CA
Zip	:	91908
Country	:	US
Telephone Number	:	866-499-1303
Fax Number	:

Provider Business Practice Location Address
First Line	:	PASEO DE LOS HEROES 9211-02
Second Line	:
City	:	TIJUANA
State	:	BAJA CALIFORNIA
Zip	:	22010
Country	:	MX
Telephone Number	:	866-499-1303
Fax Number	:

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

Provider Enumeration Date	:	04/25/2012
Last Update Date	:	04/25/2012

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