Provider Demographics
NPI:1295882330
Name:VALES, MARIA LUISA CESICAR (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIA LUISA
Middle Name:CESICAR
Last Name:VALES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 E BONITA RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3057
Mailing Address - Country:US
Mailing Address - Phone:619-427-2646
Mailing Address - Fax:619-427-2642
Practice Address - Street 1:88 E BONITA RD
Practice Address - Street 2:SUITE F
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3057
Practice Address - Country:US
Practice Address - Phone:619-427-2646
Practice Address - Fax:619-427-2642
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA432621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice