Provider Demographics
NPI:1053923540
Name:PENOLIAR, RANDY RAYMUNDO (RDA)
Entity type:Individual
Prefix:MR
First Name:RANDY
Middle Name:RAYMUNDO
Last Name:PENOLIAR
Suffix:
Gender:M
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15350 NORDHOFF ST UNIT A15350
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-2234
Mailing Address - Country:US
Mailing Address - Phone:818-724-8416
Mailing Address - Fax:
Practice Address - Street 1:15350 NORDHOFF ST UNIT A15350
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-2234
Practice Address - Country:US
Practice Address - Phone:818-724-8416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant