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NPI Code Detail

MEDICARE: DR. MARCELA MARIA LEZAMA D.D.S.

MEDICARE: DR. MARCELA MARIA LEZAMA D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist51965CA

General Provider Information

NPI Number : 1760514368
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARCELA MARIA LEZAMA D.D.S.
Provider Business Mailing Address
First Line : 24137 WILLOWBROOKE CT
Second Line :
City : SANTA CLARITA
State : CA
Zip : 91354-4937
Country : US
Telephone Number : 661-799-2881
Fax Number :
Provider Business Practice Location Address
First Line : 130 S ALVARADO ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057-2238
Country : US
Telephone Number : 213-484-9660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2007
Last Update Date : 07/08/2007

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