Provider Demographics
NPI:1770287146
Name:SANDRA LEON VAZQUEZ
Entity type:Organization
Organization Name:SANDRA LEON VAZQUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-349-6409
Mailing Address - Street 1:641 E SAN YSIDRO BLVD. #B3-1952
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173
Mailing Address - Country:US
Mailing Address - Phone:664-660-7902
Mailing Address - Fax:619-354-2449
Practice Address - Street 1:AVENIDA NEGRETE # 1577 CALLE 7 Y 8 ZONA CENTRO
Practice Address - Street 2:
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORIA
Practice Address - Zip Code:92173
Practice Address - Country:MX
Practice Address - Phone:664-660-7902
Practice Address - Fax:619-354-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty