Active NPI
Bonnie J. Retamozo, DDS, MSD
- Endodontics
- Moreno Valley, CA
National Provider Identifier
1497996078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 54396
- Practice address
- 24099 Postal Ave
Moreno Valley, CA 92553-7778 - Phone
- (951) 601-1290
- Fax
- (951) 601-1292
- NPI assigned
- Mar 12, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 54396 | CA | Primary |
Addresses
Primary practice location
24099 Postal Ave
Moreno Valley, CA 92553-7778
Mailing address
11655 Wiley St
Loma Linda, CA 92354-3964
Phone (909) 709-3482
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 54396 | Other | CA | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615420800000",
"number": "1497996078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11655 WILEY ST",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923543964",
"telephone_number": "909-709-3482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24099 POSTAL AVE",
"city": "MORENO VALLEY",
"state": "CA",
"postal_code": "925537778",
"telephone_number": "951-601-1290",
"fax_number": "951-601-1292"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RETAMOZO",
"first_name": "BONNIE",
"middle_name": "J.",
"credential": "DDS, MSD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-03-12",
"last_updated": "2021-03-11",
"certification_date": "2021-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "54396",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "54396",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moreno Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.