Healthcare Provider Details

I. General information

NPI: 1508991449
Provider Name (Legal Business Name): MARILOU ATIENZA CUASAY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1153 N LAWRENCE EXPRESSWAY
SUNNYVALE CA
94089
US

IV. Provider business mailing address

1153 N LAWRENCE EXPRESSWAY
SUNNYVALE CA
94089
US

V. Phone/Fax

Practice location:
  • Phone: 408-541-1900
  • Fax: 408-541-1588
Mailing address:
  • Phone: 408-541-1900
  • Fax: 408-541-1588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number41598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: