Provider Demographics
NPI:1750644563
Name:HERAS QUINTERO, ELIZABETH (DDS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HERAS QUINTERO
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:PMB #231
Mailing Address - Street 2:710 E SAN YSIDRO BLVD
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-3193
Mailing Address - Country:US
Mailing Address - Phone:619-948-6103
Mailing Address - Fax:
Practice Address - Street 1:CALLE FRANCISCO JAVIER MINA #1415
Practice Address - Street 2:EDIF. MEXCHINO PRIMER PISO INT. 103 ZONA RIO
Practice Address - City:TIJUANA
Practice Address - State:B.C
Practice Address - Zip Code:22320
Practice Address - Country:MX
Practice Address - Phone:619-400-3360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ4123556122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist