Provider Demographics
NPI:1679307235
Name:MOISES IRAZOQUI M
Entity type:Organization
Organization Name:MOISES IRAZOQUI M
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:
Authorized Official - Last Name:IRAZOQUI M
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:664-210-7218
Mailing Address - Street 1:210 H ST APT L12
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910
Mailing Address - Country:US
Mailing Address - Phone:619-349-6409
Mailing Address - Fax:619-354-2449
Practice Address - Street 1:DR ATL 2031-103 EDIFICIO MAPFRE
Practice Address - Street 2:ZONA RIO
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22010
Practice Address - Country:MX
Practice Address - Phone:664-210-7218
Practice Address - Fax:619-354-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty