Provider Demographics
NPI:1073623450
Name:LOTUACO, RAYMOND J (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:J
Last Name:LOTUACO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:RAYMOND LOTUACO DDS
Mailing Address - Street 2:13032 ANGELES TRAIL WAY
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342
Mailing Address - Country:US
Mailing Address - Phone:747-232-3847
Mailing Address - Fax:
Practice Address - Street 1:18279 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-3533
Practice Address - Country:US
Practice Address - Phone:661-481-3078
Practice Address - Fax:661-481-3078
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48744122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist