Healthcare Provider Details

I. General information

NPI: 1801161989
Provider Name (Legal Business Name): JOHN JAY MENDEL R.N
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 N GATEWAY BLVD SUITE 103
FRESNO CA
93727-1643
US

IV. Provider business mailing address

1951 N GATEWAY BLVD SUITE 103
FRESNO CA
93727-1643
US

V. Phone/Fax

Practice location:
  • Phone: 559-255-9965
  • Fax: 559-255-2871
Mailing address:
  • Phone: 559-255-9965
  • Fax: 559-255-2871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number392108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: