MEDICARE: MISS MARIA M MENDEZ

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	247200000X	Other Technician	56086	CA

General Provider Information

NPI Number	:	1467598136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIA M MENDEZ

Provider Business Mailing Address
First Line	:	15443 PINE AVE
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92335-4354
Country	:	US
Telephone Number	:	951-360-9793
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 N MOUNTAIN AVE
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91784-1732
Country	:	US
Telephone Number	:	909-985-0916
Fax Number	:	909-985-0893

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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Directions to “ MISS MARIA M MENDEZ ” Practice Location

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