Provider Demographics
NPI:1285089268
Name:JOSE GONZALEZ AGUAYE D.D.S.
Entity type:Organization
Organization Name:JOSE GONZALEZ AGUAYE D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GONZALEZ AGUAYE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:01152664-637-3940
Mailing Address - Street 1:4364 BONITA RD
Mailing Address - Street 2:#233
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-1421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE H# 710 ENTRE 1A 4 2A
Practice Address - Street 2:ZONA CENTRO
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22000
Practice Address - Country:MX
Practice Address - Phone:01152664-637-3940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ949364122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty