Provider Demographics
NPI:1518179779
Name:LAZAGA, MYRNA ESCOTO (DMD)
Entity Type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:ESCOTO
Last Name:LAZAGA
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 1:914 E 8TH ST
Mailing Address - Street 2:STE.208
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2567
Mailing Address - Country:US
Mailing Address - Phone:619-477-0570
Mailing Address - Fax:619-477-1813
Practice Address - Street 1:914 E 8TH ST
Practice Address - Street 2:STE.208
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2567
Practice Address - Country:US
Practice Address - Phone:619-477-0570
Practice Address - Fax:619-477-1813
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43356122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist