MEDICARE: AURELIA D MASIKIP DMD

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	45391	CA

General Provider Information

NPI Number	:	1588676761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AURELIA D MASIKIP DMD

Provider Business Mailing Address
First Line	:	1638 E 8TH ST
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950
Country	:	US
Telephone Number	:	619-474-0511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1638 E 8TH ST
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950
Country	:	US
Telephone Number	:	619-474-0511
Fax Number	:

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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