Provider Demographics
NPI:1003996869
Name:SIA-ZOL, INC.
Entity Type:Organization
Organization Name:SIA-ZOL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:SIA-ZOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-536-7005
Mailing Address - Street 1:9330 MIRA MESA BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4822
Mailing Address - Country:US
Mailing Address - Phone:858-536-7005
Mailing Address - Fax:858-536-7006
Practice Address - Street 1:9330 MIRA MESA BLVD STE F
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4822
Practice Address - Country:US
Practice Address - Phone:858-536-7005
Practice Address - Fax:858-536-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
666874OtherPROVIDER NO. UNITED CONCO
CA44085OtherSTATE LICENSE