Provider Demographics
NPI:1922134600
Name:VIZCARRA, ALEXANDER ARCEO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:ARCEO
Last Name:VIZCARRA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 YORKSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-5119
Mailing Address - Country:US
Mailing Address - Phone:562-694-8499
Mailing Address - Fax:562-946-4033
Practice Address - Street 1:14930 IMPERIAL HWY
Practice Address - Street 2:SUITE D
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-2100
Practice Address - Country:US
Practice Address - Phone:562-941-3216
Practice Address - Fax:562-946-4033
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA035799122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist