Provider Demographics
NPI:1669056792
Name:TRAVIESA, CLAUDIA MARCELA (DDS)
Entity type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:MARCELA
Last Name:TRAVIESA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 OTAY CENTER DR # 117642
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-7629
Mailing Address - Country:US
Mailing Address - Phone:619-391-0783
Mailing Address - Fax:619-363-8193
Practice Address - Street 1:PASEO DEL CENTENARIO 9580-1702
Practice Address - Street 2:DEFENSORES DE BAJA CALIFORNIA
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22010
Practice Address - Country:MX
Practice Address - Phone:619-391-0783
Practice Address - Fax:619-363-8193
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ10402778122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentist