Provider Demographics
NPI:1144520941
Name:MENDOZA, MARIA ANGELICA (CAA#00076083W)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELICA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:CAA#00076083W
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-5314
Mailing Address - Country:US
Mailing Address - Phone:619-479-9679
Mailing Address - Fax:
Practice Address - Street 1:5005 TEXAS ST
Practice Address - Street 2:STE.203
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3721
Practice Address - Country:US
Practice Address - Phone:619-692-0727
Practice Address - Fax:619-692-0785
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAA#00076083W174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist