Provider Demographics
NPI:1447767447
Name:FLORABEL F. OLIVER-BADILLO DMD, INC.
Entity Type:Organization
Organization Name:FLORABEL F. OLIVER-BADILLO DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FLORABEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:OLIVER-BADILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-566-6099
Mailing Address - Street 1:10717 CAMINO RUIZ STE 122
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2362
Mailing Address - Country:US
Mailing Address - Phone:858-566-6099
Mailing Address - Fax:
Practice Address - Street 1:10717 CAMINO RUIZ STE 122
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2362
Practice Address - Country:US
Practice Address - Phone:858-566-6099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49621261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental