Provider Demographics
NPI:1881352094
Name:NEVAREZ, SERGIO
Entity type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:
Last Name:NEVAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HERMENEGILDO GALEANA 8093
Mailing Address - Street 2:A4
Mailing Address - City:TIJUANA BC
Mailing Address - State:MEXICO
Mailing Address - Zip Code:22000
Mailing Address - Country:MX
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HERMENEGILDO GALEANA 8093
Practice Address - Street 2:A4
Practice Address - City:TIJUANA BC
Practice Address - State:MEXICO
Practice Address - Zip Code:22000
Practice Address - Country:MX
Practice Address - Phone:664-207-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ7621380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty