Provider Demographics
NPI:1568631745
Name:RAFAEL P. SUSTENTO
Entity Type:Organization
Organization Name:RAFAEL P. SUSTENTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:POBLETE
Authorized Official - Last Name:SUSTENTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-799-9828
Mailing Address - Street 1:23206 LYONS AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2672
Mailing Address - Country:US
Mailing Address - Phone:661-799-9828
Mailing Address - Fax:661-799-9823
Practice Address - Street 1:23206 LYONS AVE STE 208
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2672
Practice Address - Country:US
Practice Address - Phone:661-799-9828
Practice Address - Fax:661-799-9823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37168122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB37168-01OtherDENTI-CAL