Provider Demographics
NPI:1003235169
Name:PORTNOFF, LUIZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUIZA
Middle Name:
Last Name:PORTNOFF
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44439 17TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2831
Mailing Address - Country:US
Mailing Address - Phone:661-945-4040
Mailing Address - Fax:
Practice Address - Street 1:44439 17TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2831
Practice Address - Country:US
Practice Address - Phone:661-945-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA635721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery