Provider Demographics
NPI:1316601172
Name:LUERA HUIZAR, AIDA OLGA (DDS)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:OLGA
Last Name:LUERA HUIZAR
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 1:9 CALLE DEL MAR
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2872
Mailing Address - Country:US
Mailing Address - Phone:619-737-6024
Mailing Address - Fax:619-363-8193
Practice Address - Street 1:BLVD. RODOLFO SANCHEZ TABOADA 929
Practice Address - Street 2:STE 4
Practice Address - City:TIJUANA
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:22000
Practice Address - Country:MX
Practice Address - Phone:619-737-6024
Practice Address - Fax:619-363-8193
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8494306122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist