Provider Demographics
NPI:1073740924
Name:ROBERTO FIGUEROA
Entity type:Organization
Organization Name:ROBERTO FIGUEROA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:664-682-6713
Mailing Address - Street 1:CARLOTA SS. DE M. 749 COL DEL RIO
Mailing Address - Street 2:
Mailing Address - City:TIJUANA
Mailing Address - State:BAJA CALIFORNIA
Mailing Address - Zip Code:22200
Mailing Address - Country:MX
Mailing Address - Phone:664-682-6713
Mailing Address - Fax:
Practice Address - Street 1:3045 S ARCHIBALD AVE STE H-289
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-9001
Practice Address - Country:US
Practice Address - Phone:909-758-8075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMEXUS DENTAL PPO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZMX12866122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty