Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 51955 | CA |
NPI | 1225196165 |
---|---|
Provider Name | Dr. Antonio Maburtas Lazo |
First Address | Burbank, CA 91504-1022 |
Second Address | Bellflower, CA 90706-3677 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 08/07/2007 |