Provider Demographics
NPI:1568634384
Name:AGUILAR-CHAVEZ, MYRNA L (DDS)
Entity Type:Individual
Prefix:
First Name:MYRNA
Middle Name:L
Last Name:AGUILAR-CHAVEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41238 MARGARITA RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5552
Mailing Address - Country:US
Mailing Address - Phone:951-695-3274
Mailing Address - Fax:951-695-3276
Practice Address - Street 1:12620 MONTE VISTA RD
Practice Address - Street 2:STE D
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2531
Practice Address - Country:US
Practice Address - Phone:858-485-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice