Provider Demographics
NPI:1023288628
Name:TIZNADO, FEDERICO JESUS (DDS)
Entity type:Individual
Prefix:DR
First Name:FEDERICO
Middle Name:JESUS
Last Name:TIZNADO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 LARKSPUR CT
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1507
Mailing Address - Country:US
Mailing Address - Phone:619-482-5264
Mailing Address - Fax:619-482-5264
Practice Address - Street 1:7877 PARKWAY DR STE 2B
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2000
Practice Address - Country:US
Practice Address - Phone:619-463-6758
Practice Address - Fax:619-463-6797
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40033122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist