Healthcare Provider Details

I. General information

NPI: 1902989668
Provider Name (Legal Business Name): MICHAEL JOEL MENDOZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 UPPER RAGSDALE DR
MONTEREY CA
93940-7849
US

IV. Provider business mailing address

23 UPPER RAGSDALE DR
MONTEREY CA
93940-7849
US

V. Phone/Fax

Practice location:
  • Phone: 831-375-3577
  • Fax: 931-375-1478
Mailing address:
  • Phone: 831-375-3577
  • Fax: 931-375-1478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA77129
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA77129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: