Basic Information
| Provider Information | |||||||||
| NPI: | 1902989668 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDOZA | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JOEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23 UPPER RAGSDALE DR | ||||||||
| Address2: | |||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939407849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313753577 | ||||||||
| FaxNumber: | 9313751478 | ||||||||
| Practice Location | |||||||||
| Address1: | 23 UPPER RAGSDALE DR | ||||||||
| Address2: | |||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939407849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313753577 | ||||||||
| FaxNumber: | 9313751478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 12/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A77129 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | A77129 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.