Provider Demographics
NPI:1992922868
Name:DELA FUENTE - LEWIS, RIZA (DDS)
Entity type:Individual
Prefix:DR
First Name:RIZA
Middle Name:
Last Name:DELA FUENTE - LEWIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 E 8TH ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3167
Mailing Address - Country:US
Mailing Address - Phone:619-472-0233
Mailing Address - Fax:619-472-0234
Practice Address - Street 1:3400 E 8TH ST
Practice Address - Street 2:SUITE 214
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3167
Practice Address - Country:US
Practice Address - Phone:619-472-0233
Practice Address - Fax:619-472-0234
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist