Provider Demographics
NPI:1306114343
Name:RESENDIZ, LETIZZIA (DDS)
Entity type:Individual
Prefix:DR
First Name:LETIZZIA
Middle Name:
Last Name:RESENDIZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2374 ADIRONDACK ROW
Mailing Address - Street 2:UNIT 4
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-2633
Mailing Address - Country:US
Mailing Address - Phone:619-302-6590
Mailing Address - Fax:
Practice Address - Street 1:BLVD DIAZ ORDAZ 12950
Practice Address - Street 2:SUITE 302
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22440
Practice Address - Country:MX
Practice Address - Phone:664-681-0372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ9958691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice