Provider Demographics
NPI:1497592687
Name:LONZELLO, CHERYL D (RDH, MS)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:D
Last Name:LONZELLO
Suffix:
Gender:F
Credentials:RDH, MS
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:D
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH, MS
Mailing Address - Street 1:23433 VIA RONDA
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2232
Mailing Address - Country:US
Mailing Address - Phone:949-702-1601
Mailing Address - Fax:
Practice Address - Street 1:32341 GOLDEN LANTERN
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5343
Practice Address - Country:US
Practice Address - Phone:949-702-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13281124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist