Provider Demographics
NPI:1144817891
Name:MENDOZA, KEVIN RICKY (RN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:RICKY
Last Name:MENDOZA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31647 CHELSEA WAY
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5846
Mailing Address - Country:US
Mailing Address - Phone:760-518-7288
Mailing Address - Fax:
Practice Address - Street 1:31647 CHELSEA WAY
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5846
Practice Address - Country:US
Practice Address - Phone:760-518-7288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95140062163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health