Provider Demographics
NPI:1245652387
Name:MENDOZA, GRETEL MARIE (DNP)
Entity type:Individual
Prefix:DR
First Name:GRETEL MARIE
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:27349 JEFFERSON AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27349 JEFFERSON AVE STE 111
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5610
Practice Address - Country:US
Practice Address - Phone:949-201-8260
Practice Address - Fax:951-221-5689
Is Sole Proprietor?:No
Enumeration Date:2014-01-08
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA763562163WP0808X
CA95002233363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health