MEDICARE: DR. BERNABE BARR URBANO AMBROSIO 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	1223G0001X	General Practice Dentistry	50720	CA

General Provider Information

NPI Number	:	1952454019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNABE BARR URBANO AMBROSIO DMD

Provider Business Mailing Address
First Line	:	12120 ALTA CARMEL CT
Second Line	:	SUITE 410C
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-3864
Country	:	US
Telephone Number	:	858-385-9188
Fax Number	:	858-385-9328

Provider Business Practice Location Address
First Line	:	12120 ALTA CARMEL CT
Second Line	:	SUITE 410C
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-3864
Country	:	US
Telephone Number	:	858-385-9188
Fax Number	:	858-385-9328

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	08/17/2010

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