Provider Demographics
NPI:1053015453
Name:ANA ELVA JUAREZ BOJORQUEZ
Entity type:Organization
Organization Name:ANA ELVA JUAREZ BOJORQUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:ELVA
Authorized Official - Last Name:JUAREZ BOJORQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-349-6409
Mailing Address - Street 1:641 E SAN YSIDRO BLVD. STE #B3-407
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173
Mailing Address - Country:US
Mailing Address - Phone:664-135-2004
Mailing Address - Fax:619-354-2449
Practice Address - Street 1:AVENIDA VIENA 1616-C
Practice Address - Street 2:COL. ROMA
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22054
Practice Address - Country:MX
Practice Address - Phone:664-135-2004
Practice Address - Fax:619-354-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty