Organization
JUAN C. DEZA, INC
Active
Parent organization
JUAN C. DEZA, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
JUAN C. DEZA, INC.
Authorized official
JUAN DEZA M.D. (PRESIDENT)
(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
—
00A450580
—
CA
01
—
A45058
LICENSE NUMBER
CA
Enumeration date
10/17/2005
Last updated
03/25/2008
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