Provider Demographics
NPI:1467558338
Name:MENDOZA, RUDY STEVEN (DDS)
Entity Type:Individual
Prefix:
First Name:RUDY
Middle Name:STEVEN
Last Name:MENDOZA
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 1:392 REDONDO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814
Mailing Address - Country:US
Mailing Address - Phone:562-438-0592
Mailing Address - Fax:562-433-6442
Practice Address - Street 1:392 REDONDO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814
Practice Address - Country:US
Practice Address - Phone:562-438-0592
Practice Address - Fax:562-433-6442
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29171122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist