Individual
BONNIE J. RETAMOZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, MSD
Contact information
Practice address
24099 POSTAL AVE, MORENO VALLEY, CA 92553-7778
(951) 601-1290
(951) 601-1292
Mailing address
11655 WILEY ST, LOMA LINDA, CA 92354-3964
(909) 709-3482
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
54396
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54396
STATE LICENSE
CA
Enumeration date
03/12/2009
Last updated
03/11/2021
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