Provider Demographics
NPI:1093221830
Name:MARIA CLARISA LUKEN RASCON
Entity Type:Organization
Organization Name:MARIA CLARISA LUKEN RASCON
Other - Org Name:MARIA CLARISA LUKEN RASCON D.D.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CLARISA
Authorized Official - Last Name:LUKEN RASCON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-488-3200
Mailing Address - Street 1:4275 EXECUTIVE SQUARE
Mailing Address - Street 2:STE 200
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9123
Mailing Address - Country:US
Mailing Address - Phone:619-488-3200
Mailing Address - Fax:866-272-6924
Practice Address - Street 1:AV. A. NUM 235
Practice Address - Street 2:
Practice Address - City:ALGODONES
Practice Address - State:B.C.
Practice Address - Zip Code:21970
Practice Address - Country:MX
Practice Address - Phone:669-992-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ79531151223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty