Healthcare Provider Details

I. General information

NPI: 1053384891
Provider Name (Legal Business Name): JENNIFER NICKOL MENDEZ C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 E ILLINOIS AVE STE 406
FRESNO CA
93701-2184
US

IV. Provider business mailing address

3812 N 1ST ST
FRESNO CA
93726-4301
US

V. Phone/Fax

Practice location:
  • Phone: 559-486-8888
  • Fax: 559-486-8887
Mailing address:
  • Phone: 559-495-3120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15637
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-082513
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: