Mariaannabella Rusen Porazik, D.D.S.
Individual provider Active NPI Dentist · Lebec, CA
NPI 1821119595 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1821119595
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 55362 (CA)
- Practice address
- 2045 Lebec Rd.
Lebec, CA 93243 - Phone
- (661) 245-1434
- Fax
- (661) 245-2730
- NPI assigned
- Apr 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 55362 | CA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 55362 | CA | Yes |
Addresses
Primary practice location
2045 Lebec Rd.
Lebec, CA 93243
Mailing address
22351 Barbacoa Dr
Saugus, CA 91350-2249
Phone (661) 296-9240
Other providers in Lebec, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.