Provider Demographics
NPI:1306981162
Name:IGNACIO, MA NYZZA (DMD)
Entity type:Individual
Prefix:DR
First Name:MA NYZZA
Middle Name:
Last Name:IGNACIO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 W GLEN OAK BL
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1046
Mailing Address - Country:US
Mailing Address - Phone:818-566-1917
Mailing Address - Fax:818-566-1921
Practice Address - Street 1:1945 W GLEN OAK BL
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201-1046
Practice Address - Country:US
Practice Address - Phone:818-566-1917
Practice Address - Fax:818-566-1921
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36561122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB36561OtherDENTICAL