Healthcare Provider Details

I. General information

NPI: 1619598489
Provider Name (Legal Business Name): MONICA AISHA MENDIOLA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2020
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5406 SUNRISE BLVD STE 3
CITRUS HEIGHTS CA
95610-7854
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 800-972-5547
  • Fax: 916-887-7963
Mailing address:
  • Phone: 800-470-0071
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA58167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: