Provider Demographics
NPI:1225109895
Name:AGBUYA, MARILYN SORIANO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:SORIANO
Last Name:AGBUYA
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 1:1430 E PLAZA BLVD
Mailing Address - Street 2:SUITE E-9
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3665
Mailing Address - Country:US
Mailing Address - Phone:619-477-2254
Mailing Address - Fax:619-477-2259
Practice Address - Street 1:1430 E PLAZA BLVD
Practice Address - Street 2:SUITE E-9
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3665
Practice Address - Country:US
Practice Address - Phone:619-477-2254
Practice Address - Fax:619-477-2259
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA467191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice