Provider Demographics
NPI:1811157894
Name:ROSATO, LUZ ADRIANA (DDS)
Entity type:Individual
Prefix:DR
First Name:LUZ
Middle Name:ADRIANA
Last Name:ROSATO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:ADRIANA
Other - Last Name:CUELLAR PERDOMO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:35050 LIDO BLVD UNIT L
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-1179
Mailing Address - Country:US
Mailing Address - Phone:408-460-1366
Mailing Address - Fax:
Practice Address - Street 1:1255 WILLOW PASS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5218
Practice Address - Country:US
Practice Address - Phone:408-460-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55674122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist