Provider Demographics
NPI:1851501878
Name:PARDUCHO, URSULA VANESA (DDS)
Entity Type:Individual
Prefix:DR
First Name:URSULA
Middle Name:VANESA
Last Name:PARDUCHO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:URSULA
Other - Middle Name:VANESA
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1426 AVIATION BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4061
Mailing Address - Country:US
Mailing Address - Phone:310-376-4537
Mailing Address - Fax:310-376-0505
Practice Address - Street 1:1426 AVIATION BLVD STE 101
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4061
Practice Address - Country:US
Practice Address - Phone:310-376-4537
Practice Address - Fax:310-376-0505
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD52725Medicare ID - Type UnspecifiedRENDERING PROVIDER NUMBER