Provider Demographics
NPI:1255735379
Name:ALEJANDRA FLORES VIRGIL
Entity type:Organization
Organization Name:ALEJANDRA FLORES VIRGIL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-646-7461
Mailing Address - Street 1:416 W SAN YSIDRO BLVD
Mailing Address - Street 2:SUITE L-1617
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-2443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MAR ADRIATICO 10239-4
Practice Address - Street 2:
Practice Address - City:TIJUANA
Practice Address - State:TIJUANA
Practice Address - Zip Code:22010
Practice Address - Country:MX
Practice Address - Phone:619-646-7461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ6468458122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty