Provider Demographics
NPI:1972700029
Name:LALUZ, JOSE ABRAHAM (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ABRAHAM
Last Name:LALUZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-4602
Mailing Address - Country:US
Mailing Address - Phone:760-940-4266
Mailing Address - Fax:760-940-6124
Practice Address - Street 1:1000 EAST VISTA WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084
Practice Address - Country:US
Practice Address - Phone:760-940-4266
Practice Address - Fax:760-940-6124
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38157122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist