Provider Demographics
NPI:1669032298
Name:BERENICE CELIS
Entity Type:Organization
Organization Name:BERENICE CELIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERENICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CELIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:664-638-3234
Mailing Address - Street 1:3975 CAMINO DE LA PLAZA STE. 208-1227
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173
Mailing Address - Country:US
Mailing Address - Phone:664-638-3234
Mailing Address - Fax:858-430-3143
Practice Address - Street 1:CALLE 8 Y MADERO #1205-5, ZONA CENTRO
Practice Address - Street 2:
Practice Address - City:TIJUANA
Practice Address - State:B.C.
Practice Address - Zip Code:22000
Practice Address - Country:MX
Practice Address - Phone:664-638-3234
Practice Address - Fax:858-430-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty