Healthcare Provider Details

I. General information

NPI: 1922932664
Provider Name (Legal Business Name): DR. VICTOR JOSE MARRUFO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: VICTOR JOSE MARRUFO MENDOZA DDS

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5315 SUNRISE BLVD
FAIR OAKS CA
95628-3539
US

IV. Provider business mailing address

1100 S HILL ST APT 221
LOS ANGELES CA
90015-4297
US

V. Phone/Fax

Practice location:
  • Phone: 191-653-0248
  • Fax:
Mailing address:
  • Phone: 916-410-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: