Provider Demographics
NPI:1225238520
Name:LUZ CUBILLOS D.D.S.,INC
Entity Type:Organization
Organization Name:LUZ CUBILLOS D.D.S.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:C
Authorized Official - Last Name:CUBILLOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-988-3303
Mailing Address - Street 1:451 W GONZALES RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-9004
Mailing Address - Country:US
Mailing Address - Phone:805-988-3303
Mailing Address - Fax:805-988-0905
Practice Address - Street 1:451 W GONZALES RD
Practice Address - Street 2:SUITE 160
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-9004
Practice Address - Country:US
Practice Address - Phone:805-988-3303
Practice Address - Fax:805-988-0905
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUZ CUBILLOS D.D.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-24
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9226202Medicaid