Basic Information
| Provider Information | |||||||||
| NPI: | 1033144332 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MENDEZ | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | ISHMAEL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23625 HOLMAN HWY | ||||||||
| Address2: | |||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939405902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316222708 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 23625 WR HOLMAN HWY | ||||||||
| Address2: | |||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316222708 | ||||||||
| FaxNumber: | 8316222709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 10/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A85630 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | A85630 | CA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 770579180 | 05 | CA | MEDICAID |