Basic Information
| Provider Information | |||||||||
| NPI: | 1336707157 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MENDOZA | ||||||||
| FirstName: | ANNALEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 84501 GUITRON ST | ||||||||
| Address2: | |||||||||
| City: | COACHELLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922361372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609890544 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20342 FLANAGAN ROAD | ||||||||
| Address2: | |||||||||
| City: | TRABUCO CANYON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185828832 | ||||||||
| FaxNumber: | 8185828836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2019 | ||||||||
| LastUpdateDate: | 10/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | N | Technologists, Technicians & Other Technical Service Providers | Technician, Other | 374700000X | Y | Nursing Service Related Providers | Technician |
No ID Information.