Healthcare Provider Details

I. General information

NPI: 1811504079
Provider Name (Legal Business Name): JOANALYN LOPEZ MOJICA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 09/30/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST DNBN ATTN: CREDENTIALS 555221
CAMP PENDLETON CA
92055-5221
US

IV. Provider business mailing address

1ST DNBN ATTN: CREDENTIALS BOX 555221
DPO AA
92055-5221
US

V. Phone/Fax

Practice location:
  • Phone: 760-715-1150
  • Fax:
Mailing address:
  • Phone: 760-715-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH30571
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: