MEDICARE: MONICA AISHA MENDIOLA PA-C

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	363A00000X	Physician Assistant	PA58167	CA

General Provider Information

NPI Number	:	1619598489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA AISHA MENDIOLA PA-C

Provider Business Mailing Address
First Line	:	PO BOX 255228
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95865-5228
Country	:	US
Telephone Number	:	800-470-0071
Fax Number	:	916-854-6769

Provider Business Practice Location Address
First Line	:	5406 SUNRISE BLVD STE 3
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7854
Country	:	US
Telephone Number	:	800-972-5547
Fax Number	:	916-887-7963

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

Provider Enumeration Date	:	05/02/2020
Last Update Date	:	05/26/2026

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