Provider Demographics
NPI:1417088253
Name:GO-REYES, LEZITA TOPACIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEZITA
Middle Name:TOPACIO
Last Name:GO-REYES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 E SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-6323
Mailing Address - Country:US
Mailing Address - Phone:310-835-8820
Mailing Address - Fax:310-835-8830
Practice Address - Street 1:284 E SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-6323
Practice Address - Country:US
Practice Address - Phone:310-835-8820
Practice Address - Fax:310-835-8830
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice