Provider Demographics
NPI:1306233903
Name:MADRID, JULIO (RDA)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:
Last Name:MADRID
Suffix:
Gender:M
Credentials:RDA
Other - Prefix:
Other - First Name:JULIO
Other - Middle Name:STEPHEN
Other - Last Name:MADRID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDA
Mailing Address - Street 1:16205 SEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3383
Mailing Address - Country:US
Mailing Address - Phone:909-997-3373
Mailing Address - Fax:
Practice Address - Street 1:16205 SEVILLE AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3383
Practice Address - Country:US
Practice Address - Phone:909-997-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant