1356568091 NPI number — BABY MARIFLOR SABALBURO DUHAYLUNGSOD DMD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356568091 NPI number — BABY MARIFLOR SABALBURO DUHAYLUNGSOD DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUHAYLUNGSOD
Provider First Name:
BABY MARIFLOR
Provider Middle Name:
SABALBURO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUHAY
Provider Other First Name:
MARIFLOR
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD INC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1356568091
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
340 FOURTH AVE.
Provider Second Line Business Mailing Address:
SUITE 15
Provider Business Mailing Address City Name:
CHULA VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-422-6121
Provider Business Mailing Address Fax Number:
619-422-8082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 4TH AVE
Provider Second Line Business Practice Location Address:
SUITE 15
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91910-3813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-422-6121
Provider Business Practice Location Address Fax Number:
619-422-8082
Provider Enumeration Date:
04/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  50458 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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