Basic Information
| Provider Information | |||||||||
| NPI: | 1225754427 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDEZ | ||||||||
| FirstName: | ISAAC | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2480 LAKE ST | ||||||||
| Address2: | |||||||||
| City: | KINGSBURG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936319146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595305370 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2755 HERNDON AVE | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936116801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593244000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2022 | ||||||||
| LastUpdateDate: | 10/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WE0003X | 95208085 | CA | Y | Nursing Service Providers | Registered Nurse | Emergency |
No ID Information.