Provider Demographics
NPI:1659439883
Name:ANUNCIACION, ELAINE MENDOZA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:MENDOZA
Last Name:ANUNCIACION
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5332 MANITOWAC DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-2325
Mailing Address - Country:US
Mailing Address - Phone:310-947-4790
Mailing Address - Fax:
Practice Address - Street 1:5332 MANITOWAC DR
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-2325
Practice Address - Country:US
Practice Address - Phone:310-947-4790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA442851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice