Provider Demographics
NPI:1962521542
Name:RELATIVO, NIDA RIOGA (DDS)
Entity type:Individual
Prefix:DR
First Name:NIDA
Middle Name:RIOGA
Last Name:RELATIVO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:NIDA
Other - Middle Name:MOLINA
Other - Last Name:RIOGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:9535 RESEDA BLVD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-2310
Mailing Address - Country:US
Mailing Address - Phone:818-718-2566
Mailing Address - Fax:818-718-2479
Practice Address - Street 1:9535 RESEDA BLVD
Practice Address - Street 2:SUITE 213
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2310
Practice Address - Country:US
Practice Address - Phone:818-718-2566
Practice Address - Fax:818-718-2479
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice