Active NPI
Ericka Gabriela Mendoza, RDA
- Dental Assistant
- Pomona, CA
National Provider Identifier
1609330067
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 79582
- Practice address
- 763 Rio Rancho Rd Ste 120
Pomona, CA 91766-7015 - Phone
- (909) 766-1922
- NPI assigned
- Jan 29, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 79582 | CA | Primary |
Addresses
Primary practice location
763 Rio Rancho Rd Ste 120
Pomona, CA 91766-7015
Mailing address
4231 Evart St Apt C
Montclair, CA 91763-3518
Other names 1
- Ericka Gabriela Mendoza
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 79582 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548720000000",
"number": "1609330067",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4231 EVART ST APT C",
"city": "MONTCLAIR",
"state": "CA",
"postal_code": "917633518"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "763 RIO RANCHO RD STE 120",
"city": "POMONA",
"state": "CA",
"postal_code": "917667015",
"telephone_number": "909-766-1922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MENDOZA",
"first_name": "ERICKA",
"middle_name": "GABRIELA",
"credential": "RDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-29",
"last_updated": "2019-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "CA",
"license": "79582",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ERICKA",
"last_name": "MENDOZA",
"middle_name": "GABRIELA",
"credential": "RDA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.