Provider Demographics
NPI:1457472615
Name:LUZ CUBILLOS D.D.S., INC.
Entity Type:Organization
Organization Name:LUZ CUBILLOS D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:CONSUELO
Authorized Official - Last Name:CUBILLOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-888-7962
Mailing Address - Street 1:20434 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3110
Mailing Address - Country:US
Mailing Address - Phone:818-888-7962
Mailing Address - Fax:818-888-4923
Practice Address - Street 1:20434 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91306-3110
Practice Address - Country:US
Practice Address - Phone:818-888-7962
Practice Address - Fax:818-888-4923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty