Provider Demographics
NPI:1952626012
Name:DIMUCCI, MARINA (RDHAP)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:DIMUCCI
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8806 LILFORD AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6621
Mailing Address - Country:US
Mailing Address - Phone:760-552-0615
Mailing Address - Fax:
Practice Address - Street 1:8806 LILFORD AVE
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-6621
Practice Address - Country:US
Practice Address - Phone:760-552-0615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14583124Q00000X
CA321124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist