Provider Demographics
NPI:1326240169
Name:PENAFLORIDA, LOIDA DEL MUNDO (DMD)
Entity Type:Individual
Prefix:DR
First Name:LOIDA
Middle Name:DEL MUNDO
Last Name:PENAFLORIDA
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 1:24640 REDLANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4019
Mailing Address - Country:US
Mailing Address - Phone:909-796-1620
Mailing Address - Fax:909-796-1620
Practice Address - Street 1:24640 REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-4019
Practice Address - Country:US
Practice Address - Phone:909-796-1620
Practice Address - Fax:909-796-1620
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD35063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist