Provider Demographics
NPI:1497293278
Name:LSCJ
Entity Type:Organization
Organization Name:LSCJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIOLETA
Authorized Official - Middle Name:J
Authorized Official - Last Name:NARVAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-287-0797
Mailing Address - Street 1:2384 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2641
Mailing Address - Country:US
Mailing Address - Phone:626-286-6680
Mailing Address - Fax:626-286-7619
Practice Address - Street 1:2384 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2641
Practice Address - Country:US
Practice Address - Phone:626-286-6680
Practice Address - Fax:626-286-7619
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRANDON V. CUCCIA, DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty