Provider Demographics
NPI:1457356180
Name:SUMAZA, PATRICIO JAVIER (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIO
Middle Name:JAVIER
Last Name:SUMAZA
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 1:351 AVE HOSTOS
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-1502
Mailing Address - Country:US
Mailing Address - Phone:787-986-3636
Mailing Address - Fax:787-805-1610
Practice Address - Street 1:351 AVE HOSTOS
Practice Address - Street 2:STE 211
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1503
Practice Address - Country:US
Practice Address - Phone:787-986-3636
Practice Address - Fax:787-805-1610
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24961223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics