Healthcare Provider Details

I. General information

NPI: 1710904214
Provider Name (Legal Business Name): ROSALIA ALLAN MENDOZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3687 MT DIABLO BLVD STE 200
LAFAYETTE CA
94549-3746
US

IV. Provider business mailing address

5140 DIAMOND HEIGHTS BLVD APT 305A
SAN FRANCISCO CA
94131-1766
US

V. Phone/Fax

Practice location:
  • Phone: 925-756-3499
  • Fax:
Mailing address:
  • Phone: 415-401-0109
  • Fax: 415-282-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA87521
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA87521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: