Healthcare Provider Details

I. General information

NPI: 1689807489
Provider Name (Legal Business Name): ISABEL MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3467 W SHAW AVE SUITE #100
FRESNO CA
93711-3223
US

IV. Provider business mailing address

3354 N MARTY AVE
FRESNO CA
93722-4769
US

V. Phone/Fax

Practice location:
  • Phone: 559-274-0299
  • Fax: 559-244-0328
Mailing address:
  • Phone: 559-907-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: