Basic Information
Provider Information
NPI: 1801153770
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MENDOZA
FirstName: ERIK
MiddleName: M
NamePrefix: MR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1141 PEAR TREE LN STE 100
Address2:  
City: NAPA
State: CA
PostalCode: 945586485
CountryCode: US
TelephoneNumber: 7072541770
FaxNumber: 7072541779
Practice Location
Address1: 1141 PEAR TREE LN
Address2:  
City: NAPA
State: CA
PostalCode: 945586484
CountryCode: US
TelephoneNumber: 7072541778
FaxNumber: 7072512993
Other Information
ProviderEnumerationDate: 04/17/2012
LastUpdateDate: 12/21/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XA128962CAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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