Individual
MISS MARIA CAMILA BORRERO FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
569 W LOWELL AVE STE 200, TRACY, CA 95376-3084
(310) 498-8167
(209) 832-5885
Mailing address
569 W LOWELL AVE STE 200, TRACY, CA 95376-3084
(310) 498-8167
(209) 832-5885
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
51046
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51046
DENTAL LICENSE
CA
Enumeration date
02/23/2007
Last updated
01/22/2019
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