MEDICARE: CHRISTIAN MENDOZA-VARGAS

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	363LF0000X	Family Nurse Practitioner	95037742	CA

General Provider Information

NPI Number	:	1619806866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN MENDOZA-VARGAS

Provider Business Mailing Address
First Line	:	124 W FESLER ST
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93458-4002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 W FESLER ST
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93458-4002
Country	:	US
Telephone Number	:	805-868-5341
Fax Number	:

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

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	05/14/2026

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