Provider Demographics
NPI:1538748009
Name:GUILLERMO JIMENEZ DE LA PUENTE
Entity type:Organization
Organization Name:GUILLERMO JIMENEZ DE LA PUENTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ DE LA PUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-204-3486
Mailing Address - Street 1:1468 ASHFORD CASTLE DR.
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915
Mailing Address - Country:US
Mailing Address - Phone:686-197-5555
Mailing Address - Fax:505-551-0760
Practice Address - Street 1:AV. FRANCISCO I. MADERO 1068-A
Practice Address - Street 2:
Practice Address - City:MEXICALI
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:21100
Practice Address - Country:MX
Practice Address - Phone:619-204-3486
Practice Address - Fax:505-551-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-03
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty