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General NPI Number Information
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NPI Number | 1043310246
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Entity Type | Individual
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Provider Name | NITHYA VENUGOPAL DMD
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Gender | Female
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 68555 RAMON RD STE D101
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City | CATHEDRAL CITY
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State | CA
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Zip | 92234-3310
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Country | US
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Telephone | 951-384-6022
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Fax |
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Provider Business Mailing Address
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Address Line | 7138 BRONTE PL
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-8590
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Country | US
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Telephone | 859-494-6421
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Fax | 859-494-6421
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 59930
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License Number State | CA
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