Provider Demographics
NPI:1629314281
Name:MENDOZA, GABRIELA CRISTINA (DENTAL ASSISTANT LIC)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:CRISTINA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 LIMA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-3821
Mailing Address - Country:US
Mailing Address - Phone:323-423-6167
Mailing Address - Fax:
Practice Address - Street 1:9910 LONG BEACH BLVD STE A
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-1561
Practice Address - Country:US
Practice Address - Phone:323-563-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant