Provider Demographics
NPI:1063629897
Name:RUIZ DE LUZURIAGA, LYZA O (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYZA
Middle Name:O
Last Name:RUIZ DE LUZURIAGA
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 1:4128 VERDUGO RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3821
Mailing Address - Country:US
Mailing Address - Phone:323-256-1225
Mailing Address - Fax:
Practice Address - Street 1:4128 VERDUGO RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3821
Practice Address - Country:US
Practice Address - Phone:323-256-1225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA526811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice