Basic Information
| Provider Information | |||||||||
| NPI: | 1144520941 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDOZA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | ANGELICA | ||||||||
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| Credential: | CAA#00076083W | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2930 E 19TH ST | ||||||||
| Address2: | |||||||||
| City: | NATIONAL CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919505314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194799679 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5005 TEXAS ST | ||||||||
| Address2: | STE.203 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921083721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196920727 | ||||||||
| FaxNumber: | 6196920785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2010 | ||||||||
| LastUpdateDate: | 10/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | CAA#00076083W | CA | Y | Other Service Providers | Specialist |
No ID Information.