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4275 Executive Sq Ste 200 La Jolla CA 92037-1476 | |
| (800) 743-3900 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 4275 Executive Sq Ste 200, La Jolla, California |
| Authorized Official Name and Position | Griselda Gonzalez Granados (DENTIAT) |
| Authorized Official Contact | 8007433900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Ave. Juan De La Barrera # 610 Col. Prohogar Mexicali BAJA CALIFORNIA 21240 Ph: (011) 526-865656591 | 4275 Executive Sq Ste 200 La Jolla CA 92037-1476 Ph: (800) 743-3900 |
| NPI Number | 1356891329 |
|---|---|
| Provider Enumeration Date | 10/13/2016 |
| Last Update Date | 10/13/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356891329 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 2172627 (ZZ) | Primary |
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