Provider Demographics
NPI:1295581965
Name:GERMAN GAXIOLA
Entity type:Organization
Organization Name:GERMAN GAXIOLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAXIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-352-0417
Mailing Address - Street 1:711 ENCINAS AVE APT C
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-2531
Mailing Address - Country:US
Mailing Address - Phone:562-352-0417
Mailing Address - Fax:562-366-0560
Practice Address - Street 1:CALLE NOVENA Y RIO DEL CARMEN 871
Practice Address - Street 2:
Practice Address - City:MEXICALI
Practice Address - State:BC
Practice Address - Zip Code:21399
Practice Address - Country:MX
Practice Address - Phone:562-352-0417
Practice Address - Fax:562-366-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty