Provider Demographics
NPI:1568957132
Name:MARFORI, NINA MENDOZA (RDA)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:MENDOZA
Last Name:MARFORI
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 GLENVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-7407
Mailing Address - Country:US
Mailing Address - Phone:909-953-9992
Mailing Address - Fax:
Practice Address - Street 1:763 RIO RANCHO RD STE 120
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-7015
Practice Address - Country:US
Practice Address - Phone:909-766-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA71261126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant