Provider Demographics
NPI:1619150869
Name:MENDOZA, MELIZZA ATIENZA
Entity Type:Individual
Prefix:DR
First Name:MELIZZA
Middle Name:ATIENZA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16905 SAN FERNANDO MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-4250
Mailing Address - Country:US
Mailing Address - Phone:818-368-4661
Mailing Address - Fax:818-368-1344
Practice Address - Street 1:16905 SAN FERNANDO MISSION BLVD
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-4250
Practice Address - Country:US
Practice Address - Phone:818-368-4661
Practice Address - Fax:818-368-1344
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice