Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 1020304 | ZZ |
NPI | 1528471497 |
---|---|
Provider Name | Dr. Marta Diazchavez |
First Address | San Diego, CA 92131-2481 |
Second Address | Tijuana, BAJA CALIFORNIA 22320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2014 |
Last Update Date | 08/06/2014 |