Provider Demographics
NPI:1639634728
Name:DR FINA YVETTE MADRID DDS PC
Entity Type:Organization
Organization Name:DR FINA YVETTE MADRID DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADRID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-213-3431
Mailing Address - Street 1:300 14TH ST APT 1207
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7850
Mailing Address - Country:US
Mailing Address - Phone:619-213-3431
Mailing Address - Fax:
Practice Address - Street 1:3078 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-3034
Practice Address - Country:US
Practice Address - Phone:619-295-8891
Practice Address - Fax:619-295-8896
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR FINA YVETTE MADRID DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental