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General NPI Number Information
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NPI Number | 1457472615
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Entity Type | Organization
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Legal Business Name | LUZ CUBILLOS D.D.S., INC.
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 20434 SHERMAN WAY
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City | CANOGA PARK
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State | CA
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Zip | 91306-3110
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Country | US
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Telephone | 818-888-7962
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Fax | 818-888-4923
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Provider Business Mailing Address
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Address Line | 20434 SHERMAN WAY
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City | CANOGA PARK
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State | CA
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Zip | 91306-3110
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Country | US
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Telephone | 818-888-7962
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Fax | 818-888-4923
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Authorized Official
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Title or Position | OWENER
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Name | DR. LUZ CONSUELO CUBILLOS
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Credential | D.D.S.
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Telephone | 818-888-7962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 39040
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License Number State | CA
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