Provider Demographics
NPI:1831989185
Name:BEZANILLA CUBILLOS, MARIA I (DACM, MSTOM, LAC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:I
Last Name:BEZANILLA CUBILLOS
Suffix:
Gender:
Credentials:DACM, MSTOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CLARK ST APT 10B
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-2705
Mailing Address - Country:US
Mailing Address - Phone:619-706-8171
Mailing Address - Fax:
Practice Address - Street 1:204 CLARK ST APT 10B
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-2705
Practice Address - Country:US
Practice Address - Phone:619-706-8171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20348171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist