Provider Demographics
NPI:1942468053
Name:AMBROSIO, FEMME LLORICO (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:FEMME
Middle Name:LLORICO
Last Name:AMBROSIO
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 WALNUT AVE
Mailing Address - Street 2:SUITE 31
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4978
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:306 WALNUT AVE
Practice Address - Street 2:SUITE 31
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4978
Practice Address - Country:US
Practice Address - Phone:858-603-6345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-26
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA602501223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry