Provider Demographics
NPI:1427422575
Name:NAVARRO MEDINA, ABRAHAM (DDS)
Entity type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:
Last Name:NAVARRO MEDINA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4364 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:011-526-6468
Mailing Address - Fax:
Practice Address - Street 1:CALLE EMILIANO ZAPATA #173
Practice Address - Street 2:ZONA CENTRO
Practice Address - City:TUJUANA
Practice Address - State:CA
Practice Address - Zip Code:22000
Practice Address - Country:US
Practice Address - Phone:011-526-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ4147640122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist