Provider Demographics
NPI:1760510010
Name:VILLANUEVA, LOURDES MANGOHIG (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:MANGOHIG
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4559 W ROSECRANS AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6935
Mailing Address - Country:US
Mailing Address - Phone:310-676-0136
Mailing Address - Fax:310-676-0098
Practice Address - Street 1:4559 W ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6935
Practice Address - Country:US
Practice Address - Phone:310-676-0136
Practice Address - Fax:310-676-0098
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice