Mary Ann V Sanvictores DDS Inc

Primary specialty

DentistTaxonomy code 122300000X

License

44360 Issued in CA

Legal business name

MARY ANN V SANVICTORES DDS INC

Practice address

600 Palm Avenue
Suite 116
Imperial Beach, CA 91932-1245

Phone

(619) 628-8123

Fax

(619) 628-8081

NPI assigned

Aug 3, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Mary Ann Vergara Sanvictores, DDS

Title

Dentist Ceo

Phone

(619) 628-8123

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669480992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 PALM AVENUE",
            "address_2": "SUITE 116",
            "city": "IMPERIAL BEACH",
            "state": "CA",
            "postal_code": "919321245",
            "telephone_number": "619-628-8123",
            "fax_number": "619-628-8081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 PALM AVENUE",
            "address_2": "SUITE 116",
            "city": "IMPERIAL BEACH",
            "state": "CA",
            "postal_code": "919321245",
            "telephone_number": "619-628-8123",
            "fax_number": "619-628-8081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY ANN V SANVICTORES DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SANVICTORES",
        "authorized_official_first_name": "MARY ANN",
        "authorized_official_middle_name": "VERGARA",
        "authorized_official_title_or_position": "DENTIST CEO",
        "authorized_official_telephone_number": "619-628-8123",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "44360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.