Provider Demographics
NPI:1023184074
Name:LAGO, VIVIENNE CRUZ (DDS)
Entity Type:Individual
Prefix:
First Name:VIVIENNE
Middle Name:CRUZ
Last Name:LAGO
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 1:25846 MCBEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2004
Mailing Address - Country:US
Mailing Address - Phone:661-259-0600
Mailing Address - Fax:661-259-0633
Practice Address - Street 1:25846 MCBEAN PKWY
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2004
Practice Address - Country:US
Practice Address - Phone:661-259-0600
Practice Address - Fax:661-259-0633
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530061223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist