Dr Pablo Enrique Liciaga DDS

Primary specialty

DentistTaxonomy code 122300000X

License

49365 Issued in CA

Legal business name

DR PABLO ENRIQUE LICIAGA DDS

Practice address

2115 Bacon St
San Diego, CA 92107

Phone

(619) 224-2986

Fax

(619) 224-2982

NPI assigned

Nov 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Pablo Enrique Liciaga, DDSNPI 1033126677

Title

Dentist

Phone

(619) 224-2986

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pablo Enrique Liciaga, DDS

  • Dentist
  • San Diego, CA
  • NPI 1033126677
  NPD (past) Authorized official
• Kristina Caravelli, DMD

  • Dentist
  • San Diego, CA
  • NPI 1487310405
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422403200000",
    "number": "1295801561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2115 BACON ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92107",
            "telephone_number": "619-224-2986",
            "fax_number": "619-224-2982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 BACON ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92107",
            "telephone_number": "619-224-2986",
            "fax_number": "619-224-2982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR PABLO ENRIQUE LICIAGA DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2015-01-28",
        "status": "A",
        "authorized_official_last_name": "LICIAGA",
        "authorized_official_first_name": "PABLO",
        "authorized_official_middle_name": "ENRIQUE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "619-224-2986",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "49365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in San Diego, CA
• Providers in San Diego, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.