=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295969517
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARITES LAGAZON SOTTO DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2009
-----------------------------------------------------
Last Update Date | 03/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1907 CAMINITO DE LA CRUZ
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91913-3925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-741-4025
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1907 CAMINITO DE LA CRUZ
-----------------------------------------------------
City | CHULA VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91913-3925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-741-4025
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 58124
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------