Provider Demographics
NPI:1235345646
Name:VERDUGO, FERNANDO (DMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:VERDUGO
Suffix:
Gender:M
Credentials:DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6344 PRIMROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-2886
Mailing Address - Country:US
Mailing Address - Phone:310-709-0193
Mailing Address - Fax:626-797-7551
Practice Address - Street 1:2028 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-2450
Practice Address - Country:US
Practice Address - Phone:626-797-7551
Practice Address - Fax:626-797-0523
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA533701223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics