Mario M. Durazo, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

1266129 Issued in CA

Practice address

482 W San Ysidro Blvd
Suite 1944
San Ysidro, CA 92173-2444

Phone

(619) 781-9961

NPI assigned

Jul 10, 2013

Last updated

Jul 10, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1373414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373414400000",
    "number": "1326489097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 433996",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921433996",
            "telephone_number": "619-781-9961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "482 W SAN YSIDRO BLVD",
            "address_2": "SUITE 1944",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921732444",
            "telephone_number": "619-781-9961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DURAZO",
        "first_name": "MARIO",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-10",
        "last_updated": "2013-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "1266129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Briana Diggins
• Fernando Alfonso Dominguez, MD
• Jay Downey, M.D.
• Susan Darsann Driscoll, ARNP
• Cesar Duque Gomez, MD
• Liam M Ecker
• Jennifer Estrada
• Chitra Fernando, M.D.
• Cinthia Nathalie Figueroa
• Caitlin Louise Flewelling, LCSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2013; 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.