Provider Demographics
NPI:1629170030
Name:TAMORIA, MIRIAM JIMENEZ (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:JIMENEZ
Last Name:TAMORIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 E PLAZA BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950
Mailing Address - Country:US
Mailing Address - Phone:619-336-1536
Mailing Address - Fax:619-336-9911
Practice Address - Street 1:1132 E PLAZA BLVD
Practice Address - Street 2:STE 202
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:619-336-1536
Practice Address - Fax:619-336-9911
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9316701OtherDENTI CAL
CAB48556OtherDELTA DENTAL HEALTH FAM
CAG9316701Medicaid
CA1593206OtherUNITED CONCORDIA
CAG9316701OtherMEDI CAL