1962521542 NPI number — DR. NIDA RIOGA RELATIVO D.D.S.

Table of content: DR. NIDA RIOGA RELATIVO D.D.S. (NPI 1962521542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962521542 NPI number — DR. NIDA RIOGA RELATIVO D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RELATIVO
Provider First Name:
NIDA
Provider Middle Name:
RIOGA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIOGA
Provider Other First Name:
NIDA
Provider Other Middle Name:
MOLINA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.D.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962521542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9535 RESEDA BLVD
Provider Second Line Business Mailing Address:
SUITE 213
Provider Business Mailing Address City Name:
NORTHRIDGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91324-2310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-718-2566
Provider Business Mailing Address Fax Number:
818-718-2479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9535 RESEDA BLVD
Provider Second Line Business Practice Location Address:
SUITE 213
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91324-2310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-718-2566
Provider Business Practice Location Address Fax Number:
818-718-2479
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  39877 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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