Provider Demographics
NPI:1346987435
Name:CINTHIA G. HEREDIA
Entity Type:Organization
Organization Name:CINTHIA G. HEREDIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CINTHIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HEREDIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:644-634-3177
Mailing Address - Street 1:4364 BONITA ROAD #233
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1421
Mailing Address - Country:US
Mailing Address - Phone:619-421-6632
Mailing Address - Fax:866-864-5572
Practice Address - Street 1:GERMAN GEDOVIUS #104331, SUITE 302
Practice Address - Street 2:ZONA RIO
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIF
Practice Address - Zip Code:22010
Practice Address - Country:MX
Practice Address - Phone:664-634-3177
Practice Address - Fax:866-864-5572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty