Provider Demographics
NPI:1902967904
Name:LUCIO, JULITA MENDOZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULITA
Middle Name:MENDOZA
Last Name:LUCIO
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 1:14550 HAYNES ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1613
Mailing Address - Country:US
Mailing Address - Phone:818-650-6700
Mailing Address - Fax:
Practice Address - Street 1:14550 HAYNES ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1613
Practice Address - Country:US
Practice Address - Phone:818-650-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47938122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4793801OtherMEDICAL