MEDICARE: DR. DIEGO MENDEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	A47906	CA
2	207V00000X	Obstetrics & Gynecology Physician	A47906	CA
3	208000000X	Pediatrics Physician	A47906	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437181922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIEGO MENDEZ M.D.

Provider Business Mailing Address
First Line	:	4282 GENESEE AVE STE 201
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-4964
Country	:	US
Telephone Number	:	858-268-0300
Fax Number	:	877-409-7359

Provider Business Practice Location Address
First Line	:	4282 GENESEE AVE STE 201
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-4964
Country	:	US
Telephone Number	:	858-268-0300
Fax Number	:	877-409-7359

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	04/14/2021

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Directions to “ DR. DIEGO MENDEZ M.D.” Practice Location

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