Individual
BALTAZAR MENDOZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.D.A
Contact information
Practice address
7691 EL CHACO DRIVE, BUENA PARK, CA 90620
(562) 912-8307
Mailing address
7691 EL CHACO DR, BUENA PARK, CA 90620-1807
(562) 912-8307
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
68051
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
68051
CALIFORNIA DENTAL BOARD
CA
Enumeration date
01/22/2010
Last updated
01/22/2010
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