Healthcare Provider Details

I. General information

NPI: 1184958662
Provider Name (Legal Business Name): NORMA MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9894 GENESEE AVE
LA JOLLA CA
92037-1235
US

IV. Provider business mailing address

9894 GENESEE AVE
LA JOLLA CA
92037-1235
US

V. Phone/Fax

Practice location:
  • Phone: 619-446-8922
  • Fax: 858-626-5630
Mailing address:
  • Phone: 619-446-8922
  • Fax: 858-626-5630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: