Organization
DEKRO, A MEDICAL CORPORATION, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUAN DEZA M.D. (DIRECTOR)
(760) 439-6581
Entity
Organization
Contact information
Practice address
4002 VISTA WAY, OCEANSIDE, CA 92056-4506
(760) 439-6581
(760) 439-6585
Mailing address
3156 VISTA WAY, SUITE 405, OCEANSIDE, CA 92056-3622
(760) 439-6581
(760) 439-6585
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0076060
—
CA
Enumeration date
10/17/2005
Last updated
04/20/2008
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