Provider Demographics
NPI:1407906886
Name:VICTORIA PRASOL, DDS, INC.
Entity Type:Organization
Organization Name:VICTORIA PRASOL, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PRASOL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-297-7580
Mailing Address - Street 1:26893 BOUQUET CANYON RD STE G
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2374
Mailing Address - Country:US
Mailing Address - Phone:661-297-7580
Mailing Address - Fax:661-297-5298
Practice Address - Street 1:26893 BOUQUET CANYON RD STE G
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2374
Practice Address - Country:US
Practice Address - Phone:661-297-7580
Practice Address - Fax:661-297-5298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93575-01OtherDENTI-CAL PROVIDER ID