Healthcare Provider Details

I. General information

NPI: 1063951705
Provider Name (Legal Business Name): JOSE MENDOZA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 SAN FELIPE RD STE 12
HOLLISTER CA
95023-3035
US

IV. Provider business mailing address

321 SAN FELIPE RD STE 12
HOLLISTER CA
95023-3035
US

V. Phone/Fax

Practice location:
  • Phone: 408-710-8719
  • Fax:
Mailing address:
  • Phone: 408-710-8719
  • Fax: 408-842-0838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: