Provider Demographics
NPI:1275769283
Name:DE LA NUEZ, MARITZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:
Last Name:DE LA NUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16701 VALLEY BLVD
Mailing Address - Street 2:STE #D
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-6696
Mailing Address - Country:US
Mailing Address - Phone:909-356-4490
Mailing Address - Fax:
Practice Address - Street 1:16701 VALLEY BLVD
Practice Address - Street 2:STE #D
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6696
Practice Address - Country:US
Practice Address - Phone:909-356-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56496122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist