1548667470 NPI number — MARITESSA I. MASANGYA DDS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548667470 NPI number — MARITESSA I. MASANGYA DDS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARITESSA I. MASANGYA DDS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548667470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2207 HIGHLAND AVE.
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
NATIONAL CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91950-6905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-292-2996
Provider Business Mailing Address Fax Number:
619-292-2571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2207 HIGHLAND AVE.
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
NATIONAL CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91950-6905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-292-2996
Provider Business Practice Location Address Fax Number:
619-292-2571
Provider Enumeration Date:
11/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MASANGYA
Authorized Official First Name:
MARITESSA
Authorized Official Middle Name:
MENDOZA
Authorized Official Title or Position:
DDS/OWNER
Authorized Official Telephone Number:
619-292-2996

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  47946 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 526520 OFFICE #01 . This is a "DENTI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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