Provider Demographics
NPI:1841706660
Name:LIDIA RIVERA ORDAZ
Entity type:Organization
Organization Name:LIDIA RIVERA ORDAZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA ORDAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-234-3835
Mailing Address - Street 1:233 PAULIN AVE. #7649
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231
Mailing Address - Country:US
Mailing Address - Phone:760-234-3835
Mailing Address - Fax:858-430-3143
Practice Address - Street 1:BLVD. LAZARO CARDENAS Y PASEO GRANDES LAGOS #301
Practice Address - Street 2:
Practice Address - City:MEXICAI
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:21330
Practice Address - Country:MX
Practice Address - Phone:760-234-3835
Practice Address - Fax:858-430-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ6130002122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty