Provider Demographics
NPI:1518770171
Name:EZEQUIEL MENDOZA BECERRIL
Entity type:Organization
Organization Name:EZEQUIEL MENDOZA BECERRIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EZEQUIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA BECERRIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-352-0417
Mailing Address - Street 1:4492 CAMINO DE LA PLZ # 2408
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-3071
Mailing Address - Country:US
Mailing Address - Phone:562-352-0417
Mailing Address - Fax:562-366-0560
Practice Address - Street 1:9580 AVE PASEO DEL CENTENARIO 903
Practice Address - Street 2:
Practice Address - City:TIJUANA
Practice Address - State:BC
Practice Address - Zip Code:22010
Practice Address - Country:MX
Practice Address - Phone:562-352-0417
Practice Address - Fax:562-366-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty