Provider Demographics
NPI:1811281462
Name:MOBILIA, ANDREA JULIA (DDS)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:JULIA
Last Name:MOBILIA
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 1:783 SANTA FE LN
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-6338
Mailing Address - Country:US
Mailing Address - Phone:909-872-1878
Mailing Address - Fax:
Practice Address - Street 1:4168 N SIERRA WAY
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-3819
Practice Address - Country:US
Practice Address - Phone:909-886-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA603541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice