Individual
SAFOURA MASSOUMI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS PEDIATRIC DENTIS
Contact information
Practice address
397 E ST, STE #A, CHULA VISTA, CA 91910
(619) 425-9930
(619) 425-9887
Mailing address
397 E ST, STE #A, CHULA VISTA, CA 91910
(619) 425-9930
(619) 425-9887
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
40677
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G9226501
—
CA
Enumeration date
11/30/2006
Last updated
01/15/2013
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