Provider Demographics
NPI:1962236752
Name:SCHREIBER, KENZA
Entity type:Individual
Prefix:
First Name:KENZA
Middle Name:
Last Name:SCHREIBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 BARNETT AVE APT 3173
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4249
Mailing Address - Country:US
Mailing Address - Phone:303-588-2619
Mailing Address - Fax:
Practice Address - Street 1:34800 BOB WILSON DR STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1202
Practice Address - Country:US
Practice Address - Phone:619-532-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT140455049926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist