MEDICARE: DR. ROSA ROMANO MENDOZA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	33656	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000033656CA	OTHER	CA	DELTA DENTAL OF CALIFORNIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548529951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSA ROMANO MENDOZA D.D.S.

Provider Business Mailing Address
First Line	:	6850 BROCKTON AVE STE 106
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3814
Country	:	US
Telephone Number	:	951-683-2006
Fax Number	:

Provider Business Practice Location Address
First Line	:	6850 BROCKTON AVE STE 106
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3814
Country	:	US
Telephone Number	:	951-683-2006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2012
Last Update Date	:	05/07/2012

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