Provider Demographics
NPI:1811036676
Name:LARGOZA, NITA HUGO (DMD)
Entity Type:Individual
Prefix:MRS
First Name:NITA
Middle Name:HUGO
Last Name:LARGOZA
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 1:1040 TIERRA DEL REY
Mailing Address - Street 2:STE. 207
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7865
Mailing Address - Country:US
Mailing Address - Phone:619-482-1992
Mailing Address - Fax:619-482-1944
Practice Address - Street 1:1040 TIERRA DEL REY
Practice Address - Street 2:STE. 207
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7865
Practice Address - Country:US
Practice Address - Phone:619-482-1992
Practice Address - Fax:619-482-1944
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA402581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice