Provider Demographics
NPI:1932924149
Name:AVALOS, YURIDIA MICHELLE (DDS)
Entity type:Individual
Prefix:
First Name:YURIDIA
Middle Name:MICHELLE
Last Name:AVALOS
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:MARINERO NO. 47
Mailing Address - Street 2:
Mailing Address - City:YURIRIA
Mailing Address - State:GUANAJUATO
Mailing Address - Zip Code:38940
Mailing Address - Country:MX
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3755 MURPHY CANYON RD STE D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4412
Practice Address - Country:US
Practice Address - Phone:858-331-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1086711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice