Provider Demographics
NPI:1376663476
Name:HERDOIZA, MONICA PATRICIA (DDS)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:PATRICIA
Last Name:HERDOIZA
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 1:6915 RESEDA BLVD
Mailing Address - Street 2:#3
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4214
Mailing Address - Country:US
Mailing Address - Phone:818-881-6844
Mailing Address - Fax:818-881-7128
Practice Address - Street 1:6915 RESEDA BLVD
Practice Address - Street 2:#3
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4214
Practice Address - Country:US
Practice Address - Phone:818-881-6844
Practice Address - Fax:818-881-7128
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93798Medicare ID - Type UnspecifiedDENTICAL PROVIDER