Healthcare Provider Details

I. General information

NPI: 1316074073
Provider Name (Legal Business Name): PIONEERS MEMORIAL HEALTHCARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 CESAR CHAVEZ BLVD
CALEXICO CA
92231-2105
US

IV. Provider business mailing address

731 CESAR CHAVEZ BLVD
CALEXICO CA
92231-2105
US

V. Phone/Fax

Practice location:
  • Phone: 760-357-4850
  • Fax: 760-357-6991
Mailing address:
  • Phone: 760-357-4850
  • Fax: 760-357-6991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number255734
License Number StateCA

VIII. Authorized Official

Name: MR. RICHARD MENDOZA
Title or Position: CEO
Credential:
Phone: 760-351-3333