Provider Demographics
NPI:1356715544
Name:VILLALPANDO FALCON, MYRIAM
Entity type:Individual
Prefix:
First Name:MYRIAM
Middle Name:
Last Name:VILLALPANDO FALCON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E H ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7507
Mailing Address - Country:US
Mailing Address - Phone:619-598-6691
Mailing Address - Fax:
Practice Address - Street 1:500 E H ST APT 3
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7507
Practice Address - Country:US
Practice Address - Phone:619-598-6691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-25
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65288122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist