Provider Demographics
NPI:1285063529
Name:RAFAEL OSEGUERA
Entity type:Organization
Organization Name:RAFAEL OSEGUERA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OSEGUERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-726-0929
Mailing Address - Street 1:PO BOX 12385
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-0385
Mailing Address - Country:US
Mailing Address - Phone:915-726-0929
Mailing Address - Fax:
Practice Address - Street 1:CALLE 4, AVE. 8 Y 9 #802
Practice Address - Street 2:
Practice Address - City:AGUA PRIETA
Practice Address - State:SONORA
Practice Address - Zip Code:84200
Practice Address - Country:MX
Practice Address - Phone:01152633-338-7910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ5234312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty