Healthcare Provider Details

I. General information

NPI: 1649061300
Provider Name (Legal Business Name): MRS. MARGARITA MENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4928 E CLINTON WAY STE 108
FRESNO CA
93727-1526
US

IV. Provider business mailing address

2297 N CAROL AVE
FRESNO CA
93722-5583
US

V. Phone/Fax

Practice location:
  • Phone: 559-252-6844
  • Fax: 559-252-1121
Mailing address:
  • Phone: 559-394-4275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-LBHNWJ
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: