Provider Demographics
NPI:1033245345
Name:BORRERO FONSECA, MARIA CAMILA (DDS)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:CAMILA
Last Name:BORRERO FONSECA
Suffix:
Gender:F
Credentials:DDS
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Mailing Address - Street 1:569 W LOWELL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3084
Mailing Address - Country:US
Mailing Address - Phone:310-498-8167
Mailing Address - Fax:209-832-5885
Practice Address - Street 1:569 W LOWELL AVE STE 200
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3084
Practice Address - Country:US
Practice Address - Phone:310-498-8167
Practice Address - Fax:209-832-5885
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA510461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA51046OtherDENTAL LICENSE