Healthcare Provider Details

I. General information

NPI: 1760310965
Provider Name (Legal Business Name): JANEI LANHAM RDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7251 MAGNOLIA AVE
RIVERSIDE CA
92504-3897
US

IV. Provider business mailing address

13451 CAVANDISH LN
MORENO VALLEY CA
92553-3389
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-8557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number79587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: