Provider Demographics
NPI:1528471497
Name:DIAZCHAVEZ, MARTA (DENTIST)
Entity type:Individual
Prefix:DR
First Name:MARTA
Middle Name:
Last Name:DIAZCHAVEZ
Suffix:
Gender:F
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11067 SCRIPPS RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2481
Mailing Address - Country:US
Mailing Address - Phone:619-272-9401
Mailing Address - Fax:
Practice Address - Street 1:2340 JOSE CLEMENTE OROZCO, 5TO PISO SUITE 503,
Practice Address - Street 2:ZONA RIO
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22320
Practice Address - Country:MX
Practice Address - Phone:619-272-9401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-08
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ10203041223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health