Organization
DR PABLO ENRIQUE LICIAGA DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PABLO ENRIQUE LICIAGA DDS (DENTIST)
(619) 224-2986
Entity
Organization
Contact information
Practice address
2115 BACON ST, SAN DIEGO, CA 92107
(619) 224-2986
(619) 224-2982
Mailing address
2115 BACON ST, SAN DIEGO, CA 92107
(619) 224-2986
(619) 224-2982
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
49365
CA
Other
Enumeration date
11/28/2006
Last updated
01/28/2015
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