Healthcare Provider Details

I. General information

NPI: 1225985971
Provider Name (Legal Business Name): MEGAN MENDOZA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 BAYONET CIR
MARINA CA
93933-4600
US

IV. Provider business mailing address

617 BAYONET CIR
MARINA CA
93933-4600
US

V. Phone/Fax

Practice location:
  • Phone: 831-384-7251
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: