Provider Demographics
NPI:1750126355
Name:YENNIFER VILLA BAUTISTA
Entity type:Organization
Organization Name:YENNIFER VILLA BAUTISTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLA BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-272-9021
Mailing Address - Street 1:644 E SAN YSIDRO BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-3126
Mailing Address - Country:US
Mailing Address - Phone:619-272-9021
Mailing Address - Fax:
Practice Address - Street 1:CARRILLO PUERTO 7943-2
Practice Address - Street 2:
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22000
Practice Address - Country:MX
Practice Address - Phone:619-272-9021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty