OrganizationGuadalupeDentistDental ProvidersPractice Address2410 Jose Clemente Orozco, Tijuana, Baja California 22010 (Mexico)(619) 488-3200PECOS EnrollmentBased on the most recent information from CMS, provider Guadalupe does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1821571928Provider TypeOrganizationFull NameGuadalupeSubpartNoEnumeration Date9/13/2018Last Updated9/13/2018Contact InformationPractice LocationPractice Address2410 Jose Clemente Orozco, Tijuana, Baja California 22010 (Mexico)Phone(619) 488-3200Fax(866) 272-6924Mailing LocationMailing Address4275 Executive Sq Ste 200, La Jolla, CA 92037-1476PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNamePerea, Guadalupe Yuridia (Dentist)Phone(619) 488-3200Provider TaxonomiesCodeDescriptionLicenseCode1223G0001XPrimaryDescriptionDentistDental ProvidersLicenseUnlisted Issuer