Provider Demographics
NPI:1033635230
Name:KRIZIA D ZAMUDIO
Entity Type:Organization
Organization Name:KRIZIA D ZAMUDIO
Other - Org Name:KRIZIA D ZAMUDIO DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KRIZIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ZAMUDIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:669-992-8700
Mailing Address - Street 1:4275 EXECUTIVE SQUARE
Mailing Address - Street 2:STE 200
Mailing Address - City:LA JOLLA CA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9123
Mailing Address - Country:US
Mailing Address - Phone:619-488-3200
Mailing Address - Fax:866-272-6924
Practice Address - Street 1:INSURGENTES 910-A
Practice Address - Street 2:FRACC. MARIA FERNANDA
Practice Address - City:MAZATLAN
Practice Address - State:SINALOA
Practice Address - Zip Code:82147
Practice Address - Country:MX
Practice Address - Phone:669-992-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ6899316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty